Blog

There was a front-page story in the NY Times about the shooting of the CEO of United Healthcare. The suspect came from privilege and had a bright future. Unfortunately, he suffered from chronic LBP and did not improve with a surgical fusion of his lower back for a purported spondylolisthesis. … Read More

Luigi Mangione’s transformation from a promising academic star to an alleged murderer encapsulates the interplay of evolutionary instincts, physical struggles, and societal pressures. His story is cautionary, revealing the deeper mechanisms of stress and anger rooted in human survival instincts and their misalignment with modern life. The Evolutionary Roots of … Read More

Many people suffering from chronic pain are socially isolated. When you are trapped in pain you have a difficult time reaching out. Others do not necessarily want to interact with angry people. The problem becomes greatly magnified in that it has been shown that social rejection shares the same neurological … Read More

We do not see things as they are; we see them as we are. Anaïs Nin A fundamental concept in neuroscience and human consciousness is that our judgments and views of the world often reflect our internal state. When we judge others harshly, we are frequently projecting aspects of ourselves … Read More

Objectives We are trained that if we can solve enough of our problems, we’ll have an “enjoyable life.” Life’s challenges never stop, and we may slowly sink into darkness, “The Abyss.” We become desperate trying to escape; especially from our RUT’s (Repetitive Unpleasant Thoughts) The most effective way to dispel … Read More

Objectives: Although there is no question about the dedication of physicians to providing excellent care, the rigors of training, the demands of practice, and the business of medicine have made it increasingly difficult to treat you – a person. A major factor is doctors are not allowed the time it … Read More

When I began my surgical practice in 1986, I was convinced that spine surgery was a definitive solution for pain, and I aggressively offered many patients surgery. I eventually learned much better ways to solve pain; usually without surgery. I never dreamed that even surgical patients could have their pain … Read More

My wife and I started to play ping pong in our backyard about five years ago. We quickly discovered how relaxing it was, even for 10-15 min. It is also social and every level of player grabs the paddle and can keep the ball in play. I have played ping … Read More

Nurturing a sense of play is the main focus of the app. It is the optimal healing state of safety physiology and already exists within each of us. Play is the most powerful pathway to healing – in the right sequence. We must first unbury it in order to connect … Read More

Many years ago I was involved with helping a young friend, Larry, in his 20’s deal with a difficult legal situation involving drugs. He was a great kid and had ended up associating with friends who were on a path to hell. His father was also incredibly critical of every … Read More

The Federal government has spent billions of dollars on combating the opioid epidemic. In 2022, 1.5 billion dollars was allocated to enforcement and treatment. Yet the death toll climbed 85,000 deaths a year in 2022 to 110,000 in 2023. The estimated cost to the US economy was over 1.5 trillion … Read More

Objectives: Pain from any body part is a protective danger signal that guides our behavior and physical responses to avoid danger and remain safe. This system is called the nociceptive system, which guides behaviors to not exceed the limits of a given structure. Feedback from internal organs is called interoception, … Read More

Objectives Our survival reactions and ongoing negative program cause us to feel guilty and inadequate. We create “stories” about ourselves in order to feel better – it can’t doesn’t work. Awareness you are not your survival reactions and “self-esteem” consists of cognitive distortion frees you. AWE and awareness allow you … Read More

Objectives Many of us become upset about the state of the world, which is definitely worrisome and disturbing. However, you have no control, your nervous system is fired up, and there is not an endpoint. We all have plenty of problems that we have to deal with without adding on … Read More

The Relationship Between Chronic Stress and Health Stress is commonly perceived as a psychological term. That is simply not true. Life is not guaranteed for any living creature. Stress represents our reaction to ongoing daily threats to remaining safe. Any real or perceived mental or physical threat causes your body … Read More

Self-esteem is one of the worst concepts ever propagated. While the definition itself appears harmless enough on its surface, “confidence in one’s own worth or abilities,” the ideas surrounding self-esteem implies that if I had enough of “X,” then I would have less anxiety, less frustration, and more happiness. “X” … Read More

Being trapped by relentless untreated anxiety is the core driver of destructive human behaviour. Anxiety is the sensation generated by your body’s stress chemicals in response to a mental or physical threat. It is not primarily a psychological issue. It is a gift in that it is the mechanism that … Read More

Pain = Frustration. In the presence of unrelenting pain this frustration can be intense. Anger is a survival reaction and it is only about your needs. You become disconnected from subtle cues in your immediate surroundings and your awareness goes to zero. Lack of awareness is the essence of abuse. Although you … Read More

Gail is a woman who has been working with the DOC Journey concepts for almost a year. She had been suffering from multiple symptoms for over five years and they increased over the year prior to starting the process. She is beginning to break out of her pain cycle – … Read More

There is a deadly diagnosis that has evolved and become increasingly embedded in chronic pain terminology – Medically Unexplained Symptoms (MUS). (1) It means that you are suffering with symptoms, but we physicians don’t know the cause. Therefore, the solution is unclear, and you are going to have to do … Read More

This article was written by a journalist that I met in New York City about five years ago. My wife and I met her at the end of a long day at a publicity summit. After talking to so many people, we were a bit tired, but she instantly energised … Read More

I have observed from my personal experience and others, that anger drives depression. It is not great to have down a day, but when you start feeling sorry for yourself, the problem dramatically worsens. The anger cascade is: Circumstance – real or perceived Blaming yourself or the situation Victim role … Read More

What about the main thing in life, all its riddles? If you want, I’ll spell it out for you right now. Do not pursue what is illusionary – property and position: all that is gained at the expense of your nerves decade after decade, and is confiscated in one fell … Read More

This post is the introduction for the last leg of the updated DOC Journey course. The main course is presented in four levels with the metaphor of learning how to snow ski. The focus is on skill acquisition to regulate your body’s physiology and also reprogram your brain in the … Read More

Patient’s Letter Hi Dr Hanscom, I have been meaning to check in with you for a while now and let you know that the DOC program seems to have worked for me. My lower back & leg pain has disappeared and I’m a firm believer in the process, especially the … Read More

George was a 78 year-old businessman who acted and looked about half his age. He was pleasant and talked freely about his LBP and pain down the side of his left leg, which had been a problem for about six months. It was consistently more severe with standing and walking, … Read More

The deep need to feel and be safe is the driving force of all life, including humans. In this physiological state the body refuels, regenerates, builds muscle and bone, empties waste products, better fights off foreign invaders, and the organism thrives. Consider newborn babies who are cared for and nurtured … Read More

Looking down a hill well beyond your skill level is terrifying. Downhill skis are designed to be fast, are long, hard to turn without knowing what to do. Conversely, understanding how to use the edges, distribute your weight, time weight transfers, and position your shoulders, hips, and knees allows you … Read More

Objectives Chronic mental and physical pain are complex. Isolated interventions cannot and don’t work. Surgery is often considered a “definitive solution.” For chronic symptoms, it is not. It is simply one tool. Only two factors must be considered to make a decision regarding undergoing surgery – the anatomy and the … Read More

Bullying is maybe one of the most irrational and unacceptable aspects of the human experience. Everyone at every age, including the bullies, knows it’s wrong. Yet there doesn’t seem to be an effective way to solve it that I’ve seen in my lifetime. A major obstacle is that there are … Read More

    This is a river rock that I painted with the ocean scene to express “The healing journey is not linear!” There are highs and lows like the waves and the tides, progress and struggle but it’s all part of the healing process. One of my greatest challenges has … Read More

Objectives When your nervous system is inflamed and hyper-reactive, lesser levels of stress cause your body to go into flight or fight. In contrast, you are able to more easily deal with challenges if you feel safe and calm. Four categories of factors influence your baseline physiological state of safety … Read More

Feeling safe is the essence of enjoying life, healing, and thriving Healing chronic illness happens by moving towards health not by “fixing” yourself. An analogy can be made to becoming a professional baseball player. The goal is to be “safe” as often as possible. Your skills to process adversity and … Read More

Objectives Connecting to every aspect of your life is difficult but is at the core of allowing your body to heal. “Being” with your past may be challenging but is necessary in order to learn and grow.  It is the opposite of pursuing self-esteem, which separates you from you. The … Read More

Objectives: When you are suffering for any reason, you mind races, which makes it harder to think clearly. Doing battle with your thoughts or suppressing them makes it all worse. Simply placing your attention on a specific sensation for a short time separates you from your racing thoughts. Your body … Read More

I met Dana a few years ago after she had undergone two low back surgeries and was still experiencing a lot of pain. She engaged in the healing journey, and it was not an easy road. However, she was persistent, which is the most important factor in predicting success. She … Read More

Modern medicine is evolving in a dangerous direction with regards to your care. The major factor in deciding to offer a procedure or treatment is often whether it’s covered by insurance and how well it is reimbursed. The effectiveness of the intervention is a lesser consideration. Additionally, there is little … Read More

Objectives: Honor your suffering. You are trapped by physical and mental sensations without an apparent way out. You feel extremely isolated but many people in this hole (The Abyss) are also suffering badly. You are not alone. Your rightful frustration (rage) fires up your symptoms even more. Systematically learning and … Read More

Each of us has been given a profound gift – life. The meaning of life has been the focus of endless philosophical discussions ranging from life having no meaning to being connected to each other and the universe through deep spiritual bonds. However, the bigger question is what is the … Read More

Ringing in your ears, regardless of its intensity, is annoying. Actually, it is more than annoying; it is relentless and wears you down. It is a relatively common problem(1), numerous resources have been directed towards trying to definitively solve it, but there are few viable alternatives. Some approaches that decrease … Read More

Humans want to feel safe. Feeling or being safe reflects profound shifts in your body’s chemistry to “rest and digest.” Not only do you feel a deep sense of contentment, openness and play, your body refuels and regenerates. Your safety needs aren’t met if you don’t feel heard, validated, and … Read More

My first year in training I will never forget my first holiday season as an internal medicine resident in Spokane, WA. I learned that the holidays are a nightmare for the medicine service, especially the GI service. Diabetics don’t take their insulin and their sugars go out of control. Cardiac … Read More

Poem by Susan Angelis Photo by Susan Angelis October 29, 2023 The Walk Home The walk home from Sunday church. Walking the same path. Slightly different views each Sunday. Observing, appreciating the wondrous creations of nature. Looking beyond the iron bars. Connecting insights from the Sunday sermon to nature all … Read More

Anxiety is the “gift of life” created by sensations from the unconscious nervous system. Every living creature, from one-cell organisms to mammals processes input from its surroundings in order to navigate challenges in order to first remain alive and secondly to pass its genetic material to the next generation. The … Read More

Mental rigidity is a variation of suppressing thoughts in that you allow yourself only certain sets and types of thoughts and emotions. Your emotional/mental bandwidth is limited, and it is difficult to respond appropriatelyto social cues and signals from others. You may behave in a manner that hurts and damages … Read More

My migraine headaches began on the Fourth of July when I was five years old. By age fifty, I had over fifteen physical and mental symptoms from being in a state of sustained threat physiology. They became extreme and intolerable. I completely lost hope of ever regaining any semblance of … Read More

I often encounter a perplexing situation: A patient experiencing severe chronic pain on my spine intake questionnaire rates him or herself as a zero on a 10-point scale with regards to anxiety, depression, and anger. They may have even undergone multiple failed spine surgeries. Yet upon further, almost intrusive, questioning … Read More

A person’s stress level has a marked effect on both your central and peripheral nervous systems. The central nervous system (CNS) consists of your brain and spinal cord. The peripheral nervous system (PNS) includes all other nervous system tissue—the nerves exiting your spinal cord, all sensory receptors, and sensory and … Read More

Freely writing your thoughts and immediately destroying them has been the starting point for almost every person I have seen heal. My concept of why it is effective is because humans cannot escape their thoughts, this process allows you to separate from them. The reason to destroy them is be … Read More

One middle-aged patient sought me out in Seattle from the East Coast for a second opinion regarding his neck. He had been disabled since 2001 with chronic pain over most of his body. He had at least 10 additional symptoms of burning, aching, stabbing, and tingling that would migrate throughout … Read More

RUTs (repetitive unpleasant thoughts) are driven by our unconscious brain Here is the essence of the problem with RUTs and the human condition. The sequence begins with your unconscious brain that is constantly on alert for danger and is much more powerful than our late-evolving language-based consciousness. Humans use language … Read More

It really appears insurmountable, & the process stops and starts, but when you begin to take this course, to move in a different way with the psychology & the physiology finally finding ‘right relation’ to one another, the magic begins show itself, it just takes time – then one day, … Read More

Objectives Many people are focused on controlling anger and anxiety with behavioural approaches. These powerful reactions are not controllable and suppressing them increases threat physiology. We all need to be heard, supported, and taught methods to regulate and lower these responses. Avoiding or suppressing stress causes damage to our bodies … Read More

This is a letter I recently received from a young woman with interstitial cystitis or spastic bladder. It is a common condition that creates a lot of misery. I don’t have much experience treating patients with this problem, but it’s felt to be one of the symptoms of the Neurophysiologic … Read More

Objectives AI and the human brain both are blank slates whose functionality depends on what is loaded into them. Your capacity to navigate life depends on the quality of data and the “algorithm” loaded into your brain. Poor data or inept processing skills creates ongoing and progressive dysfunctional thoughts and … Read More

Marsha was a 36 year-old businesswoman with two young children. She was referred to me by another patient and came to see me from the east coast. She had a spontaneous onset of back pain about eight years ago. Everything possible had been tried, but she continued to spiral downward … Read More

Do You Really Need Spine Surgery? Take Control with Advice from a Surgeon considers all factors affecting your perception of pain and organizes them into a treatment grid that allows you to make a good decision regarding having spine surgery. Spine surgery is out of control. I am not against … Read More

Objectives The root cause of suicide is feeling trapped and mental and physical pain are problematic.significant reasons to feel this way. Since mental and physical pain share similar brain circuits, they both create a lot of misery. Modern medicine largely assumes illnesses and symptoms are caused by identifiable structural problems. … Read More

About three years ago, my staff noticed that our surgical patients who participated in The DOC Journey principles were doing much better. The outcomes were more consistent, and we were seeing fewer failures. The postoperative pain was more easily controlled. Patients were moving forward quickly with rehab while re-entering a … Read More

I started my practice in Seattle in 1986.  I was feeling pretty beat up from my spine training. I felt well-trained and began to perform fusions for LBP with a zeal. It was what I was trained to do.  It quickly became clear that chronic low back pain was much … Read More

Objectives Mental rigidity is a transdiagnostic process that spans many mental health diagnoses Creating mental flexibility may be an important early intervention in successfully treating them. The need to suppress unpleasant thoughts is a driver of this process. Creating mental flexibility is challenging in that people must be trained to … Read More

This is a piece sent to me through the expressive arts gallery. My arms reach upward as the mind and hair are disintegrating, reaching through burning into the light. Grounded in the earth, I dance. My heart lifts up, surrendering into light, moving with the energy, letting go of resistance, … Read More

Objectives The “C”quence of healing is connection, confidence, and creativity. You must first become aware of and connect with all aspects of your past in order to move forward. Confidence originates from being deeply connected to it. It is the antithesis of pursuing self-esteem where your efforts are spent trying … Read More

My mission falls into two broad categories. Connect mainstream medicine with existing science – most symptoms, illness and disease  are created by the body’s physiology (how it functions), and not structures. Establish the necessity of a trusting dynamic relationship with your clinician. Feeling heard and safe is not a luxury. … Read More

Objectives Avoiding danger is what keeps us alive. Humans call this signal anxiety. Avoiding this sensation drives much of dysfunctional human behaviour. We know how to stay alive but not necessary thrive. Anxiety is a physiological reaction that is about a million times stronger than the conscious brain. It cannot … Read More

Objectives Repetitive Unpleasant Thoughts (RUTs) are solvable with a multi-pronged self-directed approach. Consider the four aspects in the metaphor of a popcorn machine. They are 1) the kernels 2) the cooking pot 3) the storage compartment 4) the power source. All facets must be addressed daily, so the only person … Read More

Objectives Anxiety is an unpleasant sensation generated by your body’s physiological response to real or perceived danger. It compels you to take action to resolve the threat and live another day. If you cannot escape or solve the threat, your body’s stress response intensifies and you become angry. Anger is … Read More

Objectives Mental and physical pain are processed in similar regions of the brain. Our inability to escape from RUT’s relentlessly drives flight or fight physiology, and people may become ill. There is a healing sequence to solve them – separation of identity, thought diversion, lowering anger, moving into creativity, and … Read More

A way into “The Abyss” of chronic illness The title of this song1 is a common way many of us deal with adversity. However, it encompasses both halves of the “ironic effect” and the actual well-documented outcome of this approach to life is more worry and sadness.     What … Read More

Our society continues to wring its hands over ongoing problem of gun violence. The bigger problem is the that of societal anger, which causes us to behave badly when we are in this state. This is true for every human being, no matter how well-intentioned a person you may be. … Read More

Objectives There are many different physical and mental symptoms that are possible when you are in sustained flight or fight physiology. At my lowest point, I was experiencing 17 of them. No one could tell me what was happening despite seeing many physicians. I suffered for over 15 years. The … Read More

Objectives Spine surgery is not an option if there is not a structural problem with matching symptoms. Back pain does not respond to surgery and it is often made much worse in the presence of untreated chronic pain. It is understandable why you might choose it as it seems definitive … Read More

  Each new year, many of us spend time figuring out how we’ll make it better and also to really complete some projects that we have been putting off, maybe for decades. Few of us are able to accomplish a fraction of what we envision. Why? It’s because our unconscious … Read More

Essentially every person that has experienced deep healing has learned to process anger and nurture joy. It is much more than an intellectual exercise and deeper than “acceptance.” You don’t have to like the person or situation that harmed you. You must “let go” and move on. Anxiety is the … Read More

Jean was a 48 year-old woman who came to me from a neighboring state for a second opinion. She filled out an extensive spine pain questionnaire, which included many questions about her quality of life, in addition to a history and diagram of the pain. She was a healthy physically active … Read More

Surgery on a normal neck?? Last week, I reviewed the films of a young girl who had been in a car accident and was suffering from chronic neck pain. Her attorney sent her to a spine surgeon, who wanted to perform a five-level fusion of her neck. Her MRI was … Read More

Any skill in life, mental or physical is first learned and then embedded in our brains with repetition. This is true for physical sensory input as well as mental. In both chronic mental and physical pain, the impulses are memorised in about 6-12 months. The circuits are embedded and permanent. … Read More

The only “authentic self” that exists is the one who is present today – right this very second. Your actions and reactions reflect your entire lifetime of programming. Much of our programming is less than ideal but it is what exists. The search for your “authentic self” is futile, consumes … Read More

When I discuss the idea that you can reprogram or shift your brain circuits around away from pain, there is always a certain sense of disbelief. However, this story is a typical one with the only aspect that is a bit unusual was the speed at which the healing occurred. … Read More

Dealing with Holiday Triggers  This blog is written in conjunction with Dr. Les Aria, who is an experienced pain psychologist working in Northern California. He brings a wide range of approaches into successfully treating and solving chronic mental and physical pain. Being triggered and stressed is so common during the … Read More

You can heal by connecting to your own body’s capacity to heal. But that means connecting with every aspect of your being – including your “dark” side. It is the reason why The DOC Journey begins by acknowledging your skepticism and doubt. If you think it isn’t there, think again. … Read More

Chronic mental and physical disease are connected by a common root cause – stress. How and why? Stress (threat) creates chemical (physiological) changes in your body (fight or flight), which creates mental and physical symptoms. When you are subjected to chronic stress, the ongoing inflammation and increased fuel consumption (metabolism) … Read More

Objectives: Our core life outlook is programmed by every second of our life to the present moment. Each person has infinitely unique perspective and feel there are basic ways we “should” live our lives. When others (or ourselves) don’t meet our internal standards, we’ll often become critical and demanding. When … Read More

Objectives All of us are “wronged” every day and often multiple times. The wrongs may be real or perceived. Your choice centers around how you want to process them. Do you hold on to it them or let go and move on? You always have this choice. One problem is … Read More

This is a story of a middle-aged gentleman who became pain free using DOC Process principles. Although, he saw me primarily for back pain, it turned out that lack of sleep and anxiety were the more pressing issues. He had already seen 16 doctors in a span of eighteen months … Read More

One of the most  basic human needs in addition to survival is to feel safe. Of course, the two go hand-in-hand. But how often in our lives do we really feel safe? Feeling safe There are many benefits of feeling safe and secure, with the first one being your body’s … Read More

Objectives Our view of the world and our place in it is programmed in from the moment we are born. It becomes reinforced with age. Our relationship with food is a core example. Like many aspects of our life, we mentally punish ourselves if we don’t stick to our ideal … Read More

There is deep basic science and clinical research that documents effective treatments for chronic mental and physical disease. Most of it has not entered into clinical care and our burden of chronic disease continues to grow. In fact, much of what is being done is not only risky, based on … Read More

Each year we return to Italy to spend time with some of our close friends. My wife lived there for seven years and is fluent in Italian. For me, it is a wonderful experience, as we get to enjoy Italian culture at the ground level. One trip was to the … Read More

Objectives Forgiveness does not have to be that difficult. You are simply making a choice of not letting a situation or someone you dislike ruin your day. It specifically is part of the “input” aspect of dealing with anger. Anger is present in everyone’s life every day. There are different … Read More

  Objectives Providing yourself with cues of safety is essential to healing. However, your body instinctively gravitates towards being aware of threats. Even when life is good, your brain is constantly scanning your surroundings (including your consciousness) for danger. It is your “personal brain scanner.” As disruptive as anxiety is, … Read More

Objectives Social isolation is both a contributing factor to anxiety and also a result of it. When you are suffering, it is challenging to reach out to others in a meaningful way. The physiological effects are devastating, with significant mental and physical consequences. It even affects the expression of your … Read More

Objectives You probably have been trapped by anxiety for so long, and consumed by trying to find a way out, the idea giving back seems almost impossible. You may not even have the energy to try. Although, you have learned many strategies to process anxiety and anger, letting go and … Read More

We all know that when you try not to think about something, you’ll think about it more. Most of us don’t pay much attention to the implications of it, but it is at the core of human suffering. The underlying neurological process reflects the “ironic effect,” a term coined by … Read More

Being a victim is universal because we are victims. Life is challenging for all living creatures, including humans. We are competing for resources and a lot of behaviours are less than pleasant. Humans have an additional problem in that we have consciousness, which impacts us as much as physical threats, … Read More

Objectives Most of us strongly commit to making concrete changes at beginning of a New Year. Why can’t we follow through more consistently? The reason is because our behavioral patterns are so deeply ingrained. Just deciding to make a change won’t make it so. The commitment needed is to pursue … Read More

This is one of many stories of hope that I hear frequently. Her story is a classic illustration of how the body can heal itself if we can get out of the way. There are several principles to consider regarding the healing journey. One is that she took control. The … Read More

Preston Phillips, the spine surgeon shot this week in Tulsa, was a colleague of mine in Seattle. I did not know him well but interacted with him in conferences and some patient care. He was as well-intentioned a surgeon and nice person as I have worked with. It is easy … Read More

Objectives Connecting with your sense of play is one of the most powerful ways of shifting your physiology from threat to safety. Play circuits are also simply more pleasant. Everyone has some level of play in their life, although for some, it is quite limited. The interactions created while at … Read More

Objectives We are programmed by every second of our life up to this moment with most of it being around survival. We are inundated with internal voices warning of us danger. We are, “not good enough”, “FOMO” (fear of missing out), unattractive, are just a few examples. Predictive coding, inherent … Read More

Objectives Your brain is incredibly neuroplastic and can change quickly in whatever direction you choose. We automatically know how to feel pain. What about feeling pleasure? It gets buried in the stresses of life. Play and social connection are inherent in all of us and using feel and visualization to … Read More

I want to introduce you to Rita who holds the record in my practice for the longest time being in pain and breaking free. She had been suffering for 55 years and was still able to heal. Rita I met her in 2014, as a patient. She had been suffering … Read More

Objectives Learning any new material or skill is an active process than can only be acquired through repetition. There are few people with a photographic memory and even they need repetition to embed a skill. Living your life in the manner you wish requires many different skills, and most of … Read More

Objectives Long term change always occurs in small steps and requires persistence. The reason is that our behaviors today are programmed by our entire past life experiences. Most of your reactions are automatic, in your subconscious brain, and beyond rational control. However, you can reprogram your unconscious by repetition and … Read More

Objectives Chronic mental and physical pain is a complex problem that requires a systematic approach to solve. How can you address the issues relevant to you without and organized approach? Reprogramming your brain requires repetition but not in a random manner. It is much more efficient to solve chronic pain … Read More

Objectives Most of us intellectually understand that the only moment we have in life is this very one. That is it. Being in medicine for over 40 years has shown me the incredible unpredictability of life. Life changes in second – sudden heart attack, bad car accident, diagnosis of terminal … Read More

Objectives Most of us have become so used to solving problems and just making ends meet that we have lost sight of what we really want out of life. It is impossible to move forward without some idea of where you want to go. View you and your life as … Read More

Please do not let this happen to you, your family, or friends. The downside of failed spine surgery can be catastrophic, and it is impossible for you, as a patient, to comprehend how bad it can be. Complications happen with every surgeon, including me. That is not the issue. The … Read More

Objectives It is easy to become focused on problems to the point where you forget what you really want out of life. Most of us complain about problems – our own, other’s, society’s,, and the those of the world. But what do you want? What is the vision of your … Read More

Objectives: Regular exercise is a defined and to measurably lower inflammation, which will decrease your pain. It is basic to healing from any chronic disease, including chronic pain. It won’t solve your pain by itself, but other interventions will have limited impact without it. There are well-documented weekly recommendations regarding … Read More

 2nd Annual Pain Summit – Feb 26th and 27th, 2022     There is a growing group of health care professionals who are determined change the current trajectory of medical care. There is an ever-increasing burden of chronic mental and physical disease1, current approaches are not working, yet we are … Read More

The solutions to breaking free from the grip of chronic pain have become increasingly clear. The answers are coming from several different sources that include the research on patterns of brain activity, the role of the autonomic nervous system, fluctuations in inflammatory markers, changes in metabolism, and the collective experience … Read More

KEY POINTS When stresses overwhelm the coping capacity of your nervous system, your body will go into flight or fight physiology. You have choices regarding what you input into your nervous system. If your attention dwells on disturbing topics, you’ll remain agitated, which fires up the physiology of your whole … Read More

Objectives Anxiety is at the core of how we evolved and continue to survive. It is a gift. It is universal, powerful, automatic, and intentionally unpleasant. There is no reason to take it personally. It is not subject to rational interventions and the way to lower it is simply lowering … Read More

Written in conjunction with Dr. Les Aria, PhD  Objectives Every function and action of your body is in a delicate balance. This is achieved by every action being combined with an almost equal opposite reaction. The autonomic nervous system regulates your internal organs, and the two parts are the activating … Read More

Objectives Awareness is at the center of life. You cannot make good decisions without understanding the relevant variables. It is also an important tool in and of itself. By understanding the different types of awareness and knowing where you are in given moment, you can navigate life’s challenges more easily. … Read More

Objectives A basic trait of human consciousness is to give meaning to everything from objects to experiences. These perceptions and concepts are embedded in our brains as concretely as physical objects. They are our individual version of reality, and we live our life accordingly. By definition, we are unable to … Read More

  Objectives Human consciousness precludes suppressing thoughts and emotions without experiencing physiological consequences. You may intellectually understand that being judgmental is unkind, but it is universal and embedded in our existence. Judgements of others, positive or negative, are projections of our own self-opinion, much of which is based on cognitive … Read More

Julie Graber, 2017: July 2016, a Mal de Debarquement. Rocking, Bobbing, Swaying … 24×7 … circling in a counter-clockwise direction. Painted in the middle of one night when something under my rib cage felt like it was trying to flip over, counter-clockwise … coincidentally? So that was the first stroke … Read More

Julie Graber, 2016: a chronic neurological disorder after 8-day river cruise Prague to Budapest, Mal de Debarquement Syndrome (MdDS), for which “there is no cure”; rocking, bobbing, swaying like on a paddle board in the middle of Lake Michigan on a windy day, 24×7; co-morbid complex stress response (PTSD); highest … Read More

A deep and overwhelming feeling of helplessness became anger (which usually comes out to somehow rescue me..)..So that’s what I tried to express in this painting.   My commentary This is an interesting piece in that anger does rescue us from feeling vulnerable – physically and mentally. It is the … Read More

Objectives Much of our identity or self-esteem revolves around the “stories” we create to make sense out of the world. Many if not most of our stories involve judgment and labeling, which are classic cognitive distortions. They are not real although they seem real. Once you become aware of both … Read More

  Objectives Since emotional pain is processed in a similar manner as physical pain, why would you want to feel it? It is why our first instinct is to repress it. Repressed/ suppressed emotions fire up the nervous system even more than expressed unpleasant emotions. People spend much of their … Read More

Objectives Humans are subject to an endless barrage of unpleasant thoughts that cannot be controlled. These thoughts are sensory input that is disruptive and creates a flight or fight response. Resisting them makes them stronger. It is much more effective to switch your attention to different sensory inputs that is … Read More

Objectives Anytime you are anxious or frustrated, something from the past has invaded the present. By definition, you cannot be completely connected to what is right in front of you. To change these automatic hardwired reactions, you must first create some “space” between you and your reaction. Learning and mastering … Read More

Objectives A significant aspect of your healing journey is stimulating your brain to create a new set of circuits that are pleasurable. The sequence to change your brain is 1) awareness 2) separation (create some “space” 3) redirecting or reprogramming. None of this can happen without you being aware of … Read More

 Objectives Every action we take today is determined by what we learned from our past. Each one of us has a unique lens and our version of reality, so it is impossible to see things the way they really are. A basic step in deepening your awareness of the present … Read More

Objectives All of our actions this minute are determined by all of your past experiences up to this very second. Each of us has a unique perspective on life. Awareness involves seeing past your own personal biases and seeing the world more as it actually is. You cannot change anything … Read More

I quit my surgical spine practice in 2019 because I was seeing so much surgery performed on normally aging spines. They were causing severe damage to people’s spines and destroying their lives. Frequently, the impact was catastrophic. At the same time, I was witnessing hundreds of patients having their pain … Read More

Objectives Processing anger is more doable if it is broken down into its components. Anger is a powerful, necessary, and hard wired survival reflex. You cannot tame it with the conscious brain. It is an acquired skill that requires ongoing “adult education” in order to refine it. Framing the approaches … Read More

Objectives Anger is a hard wired automatic survival reaction, and it is impossible to get rid of, conquer, or transform it into a more constructive experience. We are not programmed to be vulnerable, so we don’t have a good reason to give up anger, nor will we ever want to. … Read More

Objectives Perfectionism is felt by many of us to be a virtue. It is reflected in terms of, “high standards,” “excellent quality,” and “strong work ethic.” It is actually a disguised version of anger directed at yourself. These ideas actually become translated our minds as, “not good enough,” “imposter syndrome,” … Read More

Objectives Most patients in chronic pain are frustrated and angry, whether they recognize it or not. Why wouldn’t they be? They are trapped by unpleasant sensory input. Unresolved anxiety is the driving force behind anger. Anger is your body’s concerted neurochemical last ditch effort to regain control. Being chronically angry … Read More

Objectives: Since the body’s response to threats affects every cell in your body, it feels like part of who you are. We spend a lot of time attempting to avoid this intentionally unpleasant sensation when it is necessary for life and also overpowering. We are trapped in life by our … Read More

Objectives: Unpleasant thoughts are impossible to avoid and can significantly impact your quality of life. They are a “neurological trick” created by your unconscious brain. They are not subject to rational interventions. The root cause of the problem is the human need for mental control. It sets off two different … Read More

Objectives: Anxiety is the sensation generated when you feel unsafe, and your body’s chemistry is stimulated into a fight or flight state. It is physiological state and not primarily a psychological one. It is not subject to rational control. Anxiety indicates danger and is the pain. It is intended to … Read More

In The DOC Journey, we have observed that the “shortcut” to healing is letting go of anger. You are then able to place your attention on what you want and your brain through the process of neuroplasticity, will respond with structural changes. You brain will develop wherever you place your … Read More

Objectives: Understanding the nature of chronic disease and the principles behind the solutions, allows you to fully engage in your care. Characteristics that keep us alive are what also create disease states. Chronic pain is a neurological diagnosis that has profound effects on your body’s physiological state. Existing in flight … Read More

Objectives: It is a common perception that if we could manage our stresses better, we’d have a better life. That is true on one level, except that the stresses that are the most damaging are the ones we can’t control. Ongoing exposure to threats creates an adverse physiology that is … Read More

A new, data-based dynamic approach is needed for medicine to successfully deal with our epidemic of chronic disease. It must acknowledge the interaction between circumstances and your body’s capacity to process them, which determines the makeup of your body’s neurochemistry. Hormones and signaling cells create mental and physical reactions to … Read More

Lesson Objectives Consider ongoing environmental input separately from your body’s responses. Understand the essence of illness/ disease is sustained exposure to real or perceived threats. It creates an adverse chemical profile that increases metabolism (your rate of fuel consumption) and causes inflammation. Your tissues will be physically damaged over time. … Read More

We are holding a weekend retreat on May 21-23, 2021 based on our past experiences at the Omega institute in Rhinebeck, NY and Talaris in Seattle, WA. These workshops continue to be the highlight of The DOC Journey experience for us. This will be a virtual workshop with a special … Read More

This blog is based on a review paper written by Dr. Robert Dantzer that discusses how resilience and immunity influence each other. (1) It is a bi-directional relationship in that poor adaptive skills stimulate the immune system; and a fired up immune system makes it harder to deal with stress. … Read More

Lesson Objectives There is deep basic science research that has revealed the nature of chronic pain and this understanding will allow you to discover your version of a solution. The essence of the problem is sustained exposure to threat and the core of the solution lies in finding safety. Create … Read More

Tom’s original story was one that I never thought was possible. He recounts his journey of undergoing 28 surgeries over 22 years in this blog. His is among many stories that has shown me that the body has a powerful capacity to heal if we can just get out of … Read More

  Dancing through the ring of fire.                           Dancing through the ring of fire.  

I always wanted to play golf at a level where I could consistently shoot in the 70’s. I began to play when I was 14 but I never took lessons and didn’t practice much. Then in college I subscribed to Golf Digest and read about a dozen golf instruction books. … Read More

Your capacity to enjoy your life, feel safe and content is dependent on your body’s neurochemical profile. When you are stressed you don’t feel good. There are methods to regulate your body’s stress reaction and inflammatory response. The gift of life Every living creature, from one-celled organisms to mammals, have … Read More

All symptoms, physical and mental, result from your body gathering data from your surroundings through multiple sensors, your brain interpreting them as safe, neutral, or threatening, and then your body responding in a manner to ensure survival. The reactions can be dictated by signals sent out directly through the nervous … Read More

This aspect of The DOC (Direct your Own Care) Journey is by far and away the most critical leg. I hear a similar story over and over and over again, “”Who would have thought it was the anger?”, or “I didn’t realize I was so angry.” Then it is inspiring … Read More

The COVID-19 virus is a member of the Corona virus family that usually just causes the common cold. The problem is that we now have a strain that is potentially fatal. However, there are some strong hints of how to survive it and it revolves around learning strategies to regulate … Read More

The burden of chronic disease is crushing us while we have the answers right in front of us. A recent summary reported that the total cost of chronic disease in the US is 3.7 trillion dollars a year, which is approximately 19.6 percent of the country’s gross domestic product. (1) … Read More

The DOC (Direct your Own Care) Journey is a collection of resources that reflect the ones many people have used to escape from the grip of chronic mental and physical pain, It includes: A guided course of seven legs and rest stops Video tutuorials Webinars Weekly group Q&A sessions Weekly … Read More

I spent a day with Bruce Lipton, a cell biologist and author of a best-selling book, The Biology of Belief. One of his major points regarding the function of the nervous system is that 95% of our nervous system is functioning from the unconscious aspect of it and only 5% … Read More

I have felt that it is important to pick out heroes to emulate. One person that I have greatly admired is an orthopedic surgeon, Paul Brand. He is the co-author of his autobiography, Pain, the Gift that Nobody Wants. (1) I knew him personally and he was as gracious a … Read More

It has become apparent that one of the most important factors in people moving away from their pain is our weekly Question and Answer sessions that we hold every Tuesday and Thursday at noon Pacific Time. We have about 25-35 participants in each session and most are present on both … Read More

The International Association for the Study of Pain (IASP) is highly regarded international society committed to research and education about pain. It was founded by one of the most prominent pioneers in pain, Dr. John Bonica. Conceptualizing pain What is pain? We toss the word around a lot without really … Read More

There is an intense relationship between anxiety and anger. Understanding this interaction is one of the most important concepts that will have a major impact in calming down your nervous system. They are, first of all, the same entity. Anxiety is the sensation generated by your autonomic nervous system’s response … Read More

Chronic pain is a complex problem consisting of many variables that affect your perception of it. Additionally, we now know that unpleasant mental input is processed in a similar manner as physical pain. Applying simple solutions to such a multi-layered problem can’t be and isn’t effective. Through many years of … Read More

There are serious mental and physical consequences from being bullied. What would be the outcome of a scenario where a stranger or acquaintance walked up to you and began to call you names and shove you. Maybe they even hit you? What would you do? You would call the authorities … Read More

Every living creature on this planet survives by processing sensory input from all of the body’s different sensors and automatically causes you to behave in a manner that keeps you safe. Secondarily, they are motivated to seek reward to allow the body to regenerate and propagate the species. Humans at … Read More

A great life isn’t just about waiting for the storm to pass, It’s about learning to dance in the rain.

One reason that chronic pain, mental or physical is consistently solvable is the brain’s property of neuroplasticity. Your brain physically constantly changes based on the nature of the sensory input. Every second, neurons, glial cells, and intracellular connections are formed and destroyed. These changes occur based on blood flow, metabolism … Read More

    Awareness is the essence of healing in that you cannot stimulate your brain to develop in a given direction, unless you know where you are starting from. Awareness is both a tool and foundation for moving forward with your life. There are four patterns of awareness that work … Read More

Once is not enough in forgiveness Perhaps this game is like weeding. The trick is to become so practiced that you can sing while you do it, that when you see one beginning to sprout you will by instinct lay your fingers in the earth, find its root, and set … Read More

Maurice is someone who I recently met and immediately was intrigued by his demeanor and outlook. My wife and I recently spent a few hours with him and his partner and had a wonderful afternoon. I was aware of his skills as an artist but had not understood that he … Read More

Humans survive on this planet by the brain receiving ongoing sensory input from the environment and interpreting it as safe, neutral or unsafe. You will act accordingly to live another day. For pain, the brain “switch” has to be on in order to feel it. Acute pain is protective and … Read More

Modern medicine has the capacity to halt this pandemic now. COVID-19 is a complex problem affecting the immune, metabolic, endocrine, nervous system, and the inflammatory response. The end result is death when there is severe tissue destruction. To solve the problem, every aspect of it must be systematically and simultaneously … Read More

I am a Registered Art Therapist in Victoria, BC. My husband is your big fan and introduced me to your website. I wanted to send this image that I created using colors and symbols to expressive somatic energy.

I first met Mark at our 2017 three-day “Rewiring Your Brain” workshop at the Omega Institute in Rhinebeck, NY. He had flown in from the Netherlands. His main problem was chronic low back pain that he had experienced for over 15 years that The workshop was based on Awareness, Hope, … Read More

      I have launched a major effort to change the way we think about disease; whether it is mental for physical. EVERY chronic disease state exhibits elevated levels of inflammatory markers. The immune system is critical for survival and this inflammatory process is supposed to destroy invaders and … Read More

The DOC process evolved from my own, mostly futile, attempts to both figure out how I fell off a cliff into the Abyss of pain within a matter of 10 minutes and then how to get back out. I tried everything, talked to anyone, had medical workups, and eventually gave … Read More

The main problem with the COVID-19 virus is not that we catch it, but that that it can kill you. There are two ways of stopping a deadly pandemic. One is through developing immunity, either by exposure to the virus or by inoculation with a vaccine. The other is to … Read More

Without or With Without desire I die Without touch I die Without conversation I die Without inspiration I die Without passion I die Without worthiness I die Without listening I die Without song I die With connection I live With full acceptance I live With freedom to exude in open … Read More

As I grow through my journey of coming to peace with chronic pain, I see the need for deep self compassion. So this painting depicts a woman connecting her belly to her heart, bringing awareness and kindness into the relationship with her body. In the glowing light of the setting … Read More

There is a basic dividing line in life that influences the development of your brain. Is your overall life outlook based on love or fear? For many of us that were raised in a less than nurturing environment, being afraid is the norm and dictates the way we respond to a … Read More

I find such tranquility in nature & creating these hidden lid gourd containers helps me feel that I am in harmony with my universe. Gourds are a living medium, and when I am touching & handling them I feel very connected to this organic plant. I dye the gourds with … Read More

For many years, I thought that for many patients there was a point of no return because the sheer magnitude of both physical and emotional trauma. I particularly felt this way with people who had undergone many failed surgeries. I was wrong and continue to hear stories of healing in … Read More

I made this doodle at the beginning of quarantine. As a social person, it’s been hard to be isolated from those that I LOVE. I’ve realized that there is no way we can do this alone. We are relational beings after all…I’m hoping we can shift out of our paradigm … Read More

The range of expressions tell the story. The wall in the studio is from 1972-72. They are collage friends. The found objects are photographed uncleaned or retouched just as they “spoke” to me. The blue face is one so a recent collage series and the wire piece was found in … Read More

My Mask project is part of my fie art practice that began around 1970 and continues today. The series includes found objects that “speak to me” and numerous collage works. They are friends, protectors, moods, mirrors and walls… an expressive vocabulary of remembrance , metaphors and metamorphosis. Will post more … Read More

This letter was sent to me by a woman that I have corresponded with a few times but I have never met or worked with. One of most powerful aspects of the DOC process is that is simply a structure that presents well-established documented treatments. Once a person understands the … Read More

“Six Feet Apart” Oil 9×12″ Currently in literal terms, this is the kind of mask that has center stage right now. When the pandemic began I hadn’t painted for quite a while. But through expressive writing & exploring emotions I decided to do a series of paintings documenting the unfamiliar … Read More

We have protected all our outside art as a reminder … This is serious!

When I saw this man playing on the street so he could make some money, I saw the expression on his face. He was in his own world and not only enjoying his music, but passionate about sharing it with others. I have found music to be a wonderful pain … Read More

Any business of that consists of more than one person involves creating a legally binding contract that spells out the expected responsibilities of each party, distribution of the rewards, and assumption of liabilities. The ultimate business is that of marriage or being legally bound together defined by time. It is … Read More

I keep coming back to this idea that there are two sides to every coin. In this time of global pandemic, masks hold a duality of both safety and fear. I’m now used to wearing a mask when out in public, but the metaphor is not lost upon me. Wearing a … Read More

This mask represents the feeling of being separated from normal life. The Coronavirus has caused the government to close my studio/gallery in Pt Reyes. I now find my life cast adrift, in a constant state of seeking balance in a world pandemic crisis. I may look calm in the outside, … Read More

Mosaico Fiorentino Fragments like colored glass Segmented memories Names of streets Distant ricordi In a flash my thoughts translate into Florentine tongue Connecting chards of glass like dots on a page my memory comes into focus An old mosaic completes itself Myself As I stay with the names new memories … Read More

Becoming myself through Balinese masks, rhythm tap and rumba. (Click the mask to see the video.)

This is a followup letter from a woman who emailed me about four years ago. I had never met her and she shared a remarkable story of recovery. Her story is one that has led me to believe that essentially anyone can learn to rewire their brain around any pain … Read More

Generation Z and Millennials as a group are struggling. In spite of living in an era of unprecedented opportunities, they are the loneliest groups. Cigna Insurance company conducted an online survey in 2018 (1) on over 20,000 people over the age of 18.  They found that over 50% of Americans … Read More

Lisa is a 58 year old high-level professional who developed chronic neck pain about 5 years ago. It began around the time she was facing some major career challenges. The pain became severe enough that she couldn’t work. She came across the DOC project a couple of years ago, and … Read More

Forgiveness is both a learned skill and an ongoing daily process without a beginning or end. It is a statement that you are going to live your life on your terms, and no one person or situation is going to take that away from you. It is the tipping point of … Read More

Ongoing anger is an absolute block to moving forward and living a truly enjoyable life. You are stuck to past. As anger is a reflection of higher elevations of stress hormones, sustained levels of them will also make you sick. The list of stress-related diseases is long and they are serious. … Read More

This is a letter from someone who I have never met. I would encourage you to read it carefully for several reasons. The first being that this is a person who was been beaten up badly by the medical system and somehow emerged out the other side doing better. Anything … Read More

This is a piece submitted by a reader, who has done well. It illustrates several aspects of the healing journey. The structure presented by the DOC process is a framework that organizes your thinking so you are able to discover your own solution. Everyone is unique and finds his or … Read More

Chronic stress can be deadly. People experiencing chronic elevations of stress hormones such as adrenaline, noradrenaline, cytokines, histamines, and cortisol mentally and physically suffer. Some of the problems include the following: Early mortality – average life span is shortened by seven years (1) Increased heart disease (2) Depression/ anxiety/suicide Autoimmune … Read More

I developed the DOC (Direct your Own Care) program after discovering that by providing a systematic approach to dealing with all aspects of a pain problem, I could almost always help patients become more functional. But more surprising to me was that not only would they improve, many would experience … Read More

Over the last several years, it has become apparent that family dynamics are a major factor in perpetuating or solving chronic pain. I am on a continual journey to learn more about these forces. At one of my annual spine society meetings, I became involved in a conversation with three colleagues … Read More

I would like to introduce you to Kendra Bloom, who is a somatic psychotherapist. She has been a wonderful resource for my patients for many years in Seattle. Although, the DOC process is largely self-directed, the journey out of suffering is always enhanced by a coach who can help you … Read More

One of the worst aspects of being trapped in chronic pain is losing hope. No one can give you a diagnosis or explain why you are so miserable, multiple ineffective treatments are failing to provide lasting relief, you are being bounced around the medical system, the pain is often unbearable … Read More

Every living creature on this planet survives by avoiding threats and gravitating towards rewards. The driving force is staying alive and survival of the species. This is accomplished by the nervous system taking in data from the environment through each body sensor and analyzing it every millisecond. All of the … Read More

There is currently an epidemic of pain in our country, and chronic pain is increasing especially rapidly in people under 40. Teen anxiety, with its many physical manifestations is particularly problematic. A few of them include: Body image disorders Eating disorders Crohn’s Disease and Ulcerative Colitis Irritable Bowel and Spastic … Read More

Depression is anxiety. It is the constellation of symptoms caused by relentless anxiety. This is critical to understand because anxiety is simply the sensation you feel when your body is full of stress chemicals, such as cortisol, adrenaline and histamines. It is the essence of your body’s neurochemical unconscious survival … Read More

Research has demonstrated what all of us already know. Repetition of unpleasant sensations worsens over time and becomes intolerable. This is particularly true with pain and the classic example is that of water torture. Although the drop of water is inherently painless, it eventually is perceived by the poor prisoner … Read More

Your brain changes every second and will evolve in whatever direction you choose. The term for this phenomenon is called, “neuroplasticity.” It is important to decide what you want in your life and what you want it to look like. As you pursue your vision, your nervous system will respond … Read More

I have been organizing an annual guy’s ski trip for over 30 years. Anywhere from 20-30 of us head to the Peruvian Lodge located at the base of the Alta Ski Resort in Utah. This year (2019), we had 30 people, with several fathers bringing their sons who are in … Read More

The essence of solving chronic pain and also creating a life that you enjoy is learning how to regulate your body’s chemistry. When you are full of stress hormones such as adrenaline, cortisol, endorphins and histamines you are on high alert and you’ll feel agitated and anxious. When this state … Read More

We have a cat, Sophia, who is remarkably attached to my wife. She may pay some attention to me when my wife isn’t around. She rolls over multiple times when my wife comes home. She will come on command to lie on my wife’s chest when we are watching TV. … Read More

I have stopped doing spine surgery and active clinical care to pursue the Back in Control project full time. This link explains my position: Why I am Leaving My Spine Surgery Practice. My vision is to bring the DOC (Direct your Own Care) principles into mainstream consciousness. It has become … Read More

  For some, the holidays are synonymous with a strong sense of familial closeness and love. However, this is not the case with many family gatherings, where relatives trigger each other, and chaos quickly ensues. If this describes your experience with the holidays, then this article is for you. I’ll … Read More

Anxiety is the body’s neurochemical reaction to a mental or physical threat. Without it you can’t survive.     It’s the sensation created by elevated levels of stress chemicals. Adrenaline – increases sensitivity and alertness Cortisol – mobilizes energy stores/ inflammation Histamines – immune system/ inflammation Endorphins – modulates the … Read More

During the last few years of practice, our team became extremely aware of the effect of chronic pain on the family and the family dynamics around pain. When a patient is in a survival mode, he or she loses awareness of the needs of those close to them. Conversely, the … Read More

  Florence, Italy, 2013 On vacation We all intellectually know that life is short and somehow we spend a lot of energy avoiding that thought. I was reminded of the frailty of life this week while vacationing in Florence, Italy. Many of the cobblestone streets are narrow and the sidewalks … Read More

When the DOC project began to evolve in 1999 it was my feeling that if there was a structural problem that it first needed to be dealt with surgically and then we could move ahead with the rest of the protocols. I define a structural problem as one that can be identified … Read More

One of the most sobering aspects of my journey in and out of chronic pain was my lack of awareness of my emotional state. My childhood wasn’t nurturing and I was surrounded by anger. Since it was my baseline environment, I didn’t define it as anger. I didn’t enjoy the … Read More

    To master a new language requires a focused commitment for an extended period of time. Say you wanted to become fluent in French. It would take years of reading books, attending classes, listening to audio tapes and probably immersing yourself in the culture for a period of time. … Read More

My brother and I attended a small private college in England in 1975. Over the last 43 years, about 25 of us have enjoyed getting together for reunions. This weekend we had our eighth one. We always have a wonderful time and it’s remarkable how we still think we all … Read More

Mark Owens’ Story This is a video that we shot of Mark Owens, who wrote the Forward of my book. I’d like to give you some additional background to his story, both from his and my perspective. He is a PhD scientist who has spent his life addressing environmental issues. … Read More

Mainstream medicine is frequently not offering you effective care. Many procedures performed for spinal problems have been documented to be ineffective. Much of the problem stems from the corporatization of medicine where the interventions that have been proven to be effective, such as ACT (acceptance commitment therapy) (1), mindfulness-based stress … Read More

No matter how many parts of my life were good, I was stuck in thinking about what I didn’t have and what could be better. It seemed to me that almost everyone else had more money,  a happier family, better athletic skills and the list was endless. In retrospect, it’s … Read More

Migraine headaches are brutal and often incapacitating. They are also one of the symptoms of a chronically stressed nervous system. Adrenaline decreases the blood supply to the frontal lobe of the brain and when you relax the vessels re-expand and then you have a screaming headache. Often it’s accompanied the … Read More

I received this email from a physical therapist on the East Coast, who I’ve never met. He’d heard about my work on a podcast. Before you read this letter, I’d like to emphasize that research has documented for decades that arthritis, bone spurs, disc degeneration, disc bulges and herniations are … Read More

“I am asking you to not give ANY advice to any member of your family for the next month and hopefully indefinitely; especially your children.” This is the foundation of creating functional family dynamic, especially with those dealing with chronic pain. Chronic pain takes a terrible toll on families. People … Read More

A few years ago, I attended a four-day workshop held by Dr. David Burns, who is a Stanford psychiatrist and the author of Feeling Good. It was his book that was the first step in pulling me out of tailspin into The Abyss of pain. I wanted to meet him … Read More

This story is from a woman, who I met at our first Omega workshop in 2013. I was holding the workshop with Dr. Fred Luskin, who is a Stanford psychologist and author of Forgive for Good and also my wife, Babs Yohai, who is a professional dancer and taught rhythm to the … Read More

Our next weekend workshop will be held this summer at the Omega Institute in Rhinebeck, NY. The dates are Friday evening, June 29th until Sunday noon, July 1st. The intent of the program is to create a structured safe environment where you can connect to your capacity to heal through … Read More

    Beginning in 2003, I suffered low back pain in the L4-5 region. I saw a chiropractor from time to time but in 2009 my treatments began to be on a regular basis and he advised that as long as I stayed at my current desk job and it … Read More

  Each new year, many of us spend time figuring out how we’ll make it better and also to really complete some projects that we have been putting off, maybe for decades. Few of us are able to accomplish a fraction of what we envision. Why? It’s because our unconscious … Read More

People trigger each other and the closer the relationship, the stronger the reactions. When you become anxious or frustrated, you’re in a survival mode that’s impossible to control. It’s ironic that our most important relationships are also often a source of frustration. You can undergo many medical treatments for your … Read More

The DOC Journey began to evolve in 2003, as I emerged from my own 15-year struggle with chronic pain. It took me a long time to figure out how I ended up being in this state and even longer to understand what had allowed me to escape. Then I was … Read More

I saw two movies and a show this month that highlighted many issues about the human condition and pain. I first saw the 2015 movie, Cinderella, then a show, Ain’t Too Proud, which was a musical about the Motown group, The Temptations, and finally a movie, The Florida Project. I … Read More

  After my fourth L3-L4 surgery the neurosurgeon sat me down and said “…you are not going to get better but rather worse as you grow older. You have a life sentence of pain.” I’ve had 6 spinal surgeries and 20 additional surgeries. I know chronic pain intimately. After 25 … Read More

“Prehab” is refers to a patient engaging in a rehabilitation process before surgery. There are well-documented factors that affect pain and surgical outcomes. It’s important to implement treatments to address all of them prior to undergoing a procedure with significant risks. Chronic pain infiltrates every aspect of life. You have … Read More

Watching a baby take in every aspect of his or her surroundings with curiosity and awe is wonderful, delightful and inspiring. The capacity to learn is almost infinite. Their laughter is contagious and when they are upset they show it. They are completely connected to what is right in front … Read More

My wife and I were at a wedding this weekend. The bride was the daughter of some of our closest friends. She and her new husband are a wonderful couple. The excitement and energy around supporting them in their new venture together was electric. Their commitment to each other was … Read More

It is becoming increasingly clear that chronic pain has a tremendous impact on your immediate family. One of the more direct ways is through mirror neurons. I frequently tell my patients that when you smile at a baby the reason the baby smiles back is not because the baby is … Read More

It has been my observation that suffering from chronic pain affects almost every aspect of your life, especially trying to enjoy yourself. Every enjoyable experience is lessened in the context of pain. You may be able to successfully distract yourself for a bit and not even experience the pain, but … Read More

I had a rough start living in a chaotic household with an angry mother who suffered from chronic pain. I did not figure out for 50 years that the migraine headache I suffered at age five would be the beginning of a lifetime filled with chronic pain. I eventually experienced … Read More

Becoming socially isolated often occurs when suffering in pain. Additionally, the area of the brain that lights up is similar to the same circuits that are active in chronic pain. The effects of being isolated will play off of each other and you can spiral downward quickly. Loneliness There is … Read More

Deciding whether to undergo spine surgery is one of the most important choices you will ever make. Currently, failed spine surgery is so common there is even a separate diagnosis for it – “Failed Back Surgery Syndrome.” You do not want to become one of these people, as it usually … Read More

It has become increasingly apparent to me that chronic pain is a family issue. Your deepest human interactions happen at home and members trigger each other. These powerful reactions have severe consequences. Partners and parents often end up acting in ways that they would not tolerate in their children. How … Read More

Humans spend a good part of their life energy creating and maintaining something called “self-image.” Thanks to parents, peers, and the socialization process, we are conditioned to identify with an “image” of our “selves.” While this conditioning is well-intentioned, it can wreak havoc in our lives. It is only about … Read More

I will be holding a weekend workshop this July at the Omega Institute in Rhinebeck, NY. This will be my fourth workshop at Omega. The results have been overwhelmingly satisfying. As in the past, joining me will be my wife, Babs Yohai, who is a professional dancer; and my daughter … Read More

Video animation of a lumbar fusion The purpose of this letter is to explain what is involved when a posterior fusion is performed on your lower back.  We have found that the more knowledgeable the patient, the more successful the surgical outcome.  Patients undergoing this procedure most commonly ask the … Read More

Hi Dr. Hanscom, It’s Donna, a former patient. I just wanted to write and tell you some good news regarding my back situation. You were right about forgiveness as well as the emotional aspects of back pain–at least in my case. After following the physiological recommendations and taking the various … Read More

A seventy-three-year-old woman—let’s call her Dorothy for the sake of this story—was understandably apprehensive. She had just been told that she needed an eight-level spine fusion from her tenth thoracic vertebra to her pelvis, so she came to me for a second opinion. Dorothy was a retired National Guard armed … Read More

“I am the biggest ever skeptic. But I thought what the heck. My lower back pain has been very bad and persistent whenever I stand or walk for more than a minute. I read the forward and immediately began using the ‘expressive writing.’ You take paper and pen/pencil and write, … Read More

Neil Hilborn – “OCD” Obsessive Compulsive Disorder (OCD) is an extreme of form of anxiety. It is characterized by a relentless assault of unwelcome intrusive thoughts. I suffered from OCD for several decades well before I knew what OCD meant. The beginning My anxiety became disruptive one night in 1990 … Read More

I have long asked the spouses/ partners of my chronic pain patients to participate in the DOC project (“Direct your Own Care”—my step-by-step method that allows patients to take control of their treatment plan). One reason is that partners of chronic pain patients also experience suffering—they have their own broken … Read More

I have held several three and five-day workshops in Rhinebeck, NY at the Omega Institute with Dr. Fred Luskin, a Stanford psychologist and author of Forgive for Good, my wife, Babs Yohai, a professional tap dancer, and my daughter, Jasmine Yohai-Rifkin who is an expressive arts therapist. The tightly-structured seminar is based … Read More

One of the tenets of successfully solving chronic pain is to stop discussing your pain with others. Dwelling on your pain only strengthens those neural pathways and therefore reinforces your perception of pain. Over the last couple of years, I have seen evidence that has made this notion clearer to … Read More

Compassion: Empathy in the Face of Chronic Pain Empathy is an inherent part of the human experience.     Being labeled as a “chronic pain patient” is one of the worst aspects of an already terrible problem. It’s impossible to be truly seen or heard if you are viewed in … Read More

Louis Cozolino, in his exhaustive book The Neuroscience of Human Relationships, points out that that human consciousness developed through interacting with other humans. We all know that people seek connection with others and when deprived of it develop significant health problems. We will do almost anything to stay connected. It … Read More

Your experience of pain depends on many parts of your brain receiving a signal, and comparing it to your expectations based on past experience. Recent research is confirming this on functional MRI (fMRI) scans that look at what part of the brain lights up in response to sensory input. Pain … Read More

The most powerful treatment for any disorder is engaging in practices that calm your nervous system and allows your body to heal itself. Each person has his or her unique way of accomplishing this. I was introduced to this concept in the 1980’s by Dr. Bernie Siegel’s book, Love, Medicine … Read More

This was the highlighted title of an article in the Sports Sunday section of the NY Times a few weeks ago. Of course, it tweaked my interest and I was introduced to an event that I did not dream possible. The article talked about about the Quintuple Anvil Triathlon held … Read More

Your body is a lean and mean fighting machine. That is all it is designed for and intended to do. We somewhat cheated nature in that we possess consciousness and language so we are able to control and manipulate our environment to our advantage. Human consciousness is a recent development. … Read More

You must understand the nature of a problem before you can solve it. It is well-publicized that over 100 million people suffer from varying degrees of chronic pain in the US alone. As I talk to colleagues around the world, it is clear that it an international problem. So whatever … Read More

We live in an era of unprecedented comfort and freedom. A recent experience that drove this home was spending a few days in New Orleans. As my wife and I were on a walking tour through the French Quarter, our guide pointed out that it was not until 1890 that … Read More

There have been numerous terms used to describe the body’s response to chronic stress and the physiological response. The original descriptor was Tension Myositis Syndrome (TMS) coined by Dr. John Sarno in the 1970’s. Other terms have included Stress Illness Syndrome, Psychosomatic Disorders, Central Sensitization Syndrome (CSS), and Mind Body … Read More

  The ability to process anxiety in a healthy way is critical to maintaining your quality of life. It is even more important for someone who is experiencing chronic pain. Anxiety is a reflection of your body chemistry changes when you are in an arousal state. Your senses are heightened … Read More

There are two fundamental aspects to the perception of pain: The source: Three Sources of Chronic Pain Possible structural problem Inflammation of soft tissues Neurophysiological Disorder – “short circuits” The receptor—your brain Three additional variables affect your perception of pain: Sensitization Memorization The “Modifiers” –1) anxiety 2) anger 3) sleep … Read More

There have been numerous terms used to describe the body’s response to chronic stress and the physiological response. The original descriptor was Tension Myositis Syndrome (TMS) coined by Dr. John Sarno in the 1970’s. Other terms have included Stress Illness Syndrome Psychosomatic Disorders Central Sensitization Syndrome (CSS) Mind Body Syndrome … Read More

Moving Forward with Your Pain Objectives Most of us are under the impression that you must first solve your chronic pain before you can move forward and enjoy your life. It is actually the opposite scenario. You have to fully engage in life in order to move away from your … Read More

Objectives Modern civilization offers more opportunities than any other era of human history. Yet our mental health is declining. We have been led to believe that experiences, knowledge, possessions, and accomplishments can make us happy. You cannot outrun your mind. It is a futile effort because your unconscious survival reactions … Read More

When I first met Sarah, she was close to 75 and had been experiencing debilitating pain for decades. But, since her spine x-rays revealed only normal degeneration consistent with her age, I set her to work on the DOC process. After about a year of working diligently through the tools, … Read More

These four elements form a powerful alliance to connect to your own capacity to heal, which is the essence of the solution to chronic pain. The DOC program is a framework that allows you to organize your thinking around these age-old concepts. Awareness You cannot successfully address any problem without … Read More

“The essence of the DOC process is simply chilling out and moving on. One cannot happen without the other. This is a corollary of the other basic principle that it is important to move forward with your life with or without your pain. If you are waiting for your pain … Read More

The second edition of Back in Control: A Surgeon’s Roadmap Out of Chronic Pain will be available November 17th, 2016. Why did I write a second edition? The first book was based on my personal experience and observing the successes with my patients. A great deal of new neuroscience research … Read More

Whenever your peace of mind is at the mercy of your external circumstances, you are at the mercy of them. The essence of taking your life back is disconnecting from this energy. There are many levels and ways of doing this. Some of them include: Forgiveness – is a selfish … Read More

Objectives: Adequate sleep is a necessary requirement for healing. Insomnia is a cause of chronic pain, and it is not the other way around. It is almost always possible to experience a consistently good night’s sleep using a combination of approaches. Do not undergo any major invasive interventions until you … Read More

I have always enjoyed hard work. I began working in heavy construction at age fourteen during the remodeling of our house. I fell in love with it and kept working at it for another 18 years. I poured concrete slabs, framed, did some finish work, plumbing, and spent three summers … Read More

Anxiety is the sensation created by elevated levels of stress hormones in response to a threat. It is intended to be unpleasant enough to compel you to take action to resolve the situation. We will do anything to avoid it. The expected and required response is to take control. However, … Read More

To say that the wave of mass shootings over the last few years is disturbing would be grossly understating how most of us feel. One of the most basic of human needs is to feel safe and we largely depend on our society being reasonably civilized. We count on our … Read More

For those of you who are golfers, you know that golf is a great metaphor for life. It is both challenging and social. I think the bonding is a result of such deeply shared suffering. What is fascinating is that it really is just a game. This is a story … Read More

I was landing in Salt Lake City to spend Father’s Day weekend with my son and daughter-in-law. While standing at baggage claim I heard a father yelling at his daughter to hold still. I looked down and saw a remarkably cute five-year-old little girl with curly hair being stopped in … Read More

I want to share an email I received from a colleague regarding the effect of the DOC (Direct your Own Care) process in his practice. He is a retired orthopedic surgeon who is currently practicing addiction medicine. He and I had been in touch and I was helping him bring … Read More

Print this letter Laminectomy: Video animation Laminotomy: Illustrations What is a laminae? The spinal column consists of vertebra and disc as the front part of the spine, the spinal canal which contains the dural sac filled with fluid surrounding the spinal cord and nerves and the back part of the … Read More

Print this letter Video animation: Microdiscectomy The purpose of this letter is to explain the microdiscectomy procedure. A microdiscectomy is the removal of an intervertebral disc fragment next to a nerve in your lower back. We have found that the more knowledgeable you are, the better you’ll be able to … Read More

Ernie presented to me a few years ago with severe back and leg pain. He had undergone two spine fusions for LBP about 10 years earlier that had not been helpful. His three lowest vertebra had been fused from L4 to the sacrum. Additionally, he now had severe leg pain … Read More

I received this email from someone that I had never met. I’ve now gotten to know her and she is delightful. A physician had recommended my book and here is her story. A rough road I have read your book Back in Control many times (which I refer to as … Read More

Neuroplasticity is the term for the brain’s capacity to physically adapt to the environment. This is modulated by sensory input and chemical changes. It has been well-documented that prolonged exposure to stress hormones adversely affects the brain structure in addition to causing it to physically shrink.(1) Having a chronically negative … Read More

I have had the distinct privilege of getting to know Dr. Bernie Siegel, who is a retired pediatric general surgeon and author of several books, including Love, Medicine and Miracles. He has looked extensively at the stories of patients who are survivors of advanced cancer and documenting common traits in … Read More

Objectives: Chronic pain is a complex multi-organ disease. It is reason why there are so many different symptoms. It cannot be successfully solved with random simplistic treatments directed at just the symptoms. Addressing the root cause of stresses overwhelming your nervous system’s coping capacity requires a multi-pronged self-directed approach. It … Read More

I have been considering this question since I was eight years old. For some reason it was a subject that my father felt was important. It was his contention that mental health was more important. I have historically felt that physical health was the foundation of a productive life. Since … Read More

I received an email from an orthopedic colleague who I have never personally met. We are both part of an Internet discussion group about chronic pain and disability. His observations were very succinct and I think summarizes the problem of physicians not being adequately trained in chronic pain. Here is … Read More

Every second of your life depends on your brain scanning your surroundings for trouble. This unconscious process guides your behavior so as to avoid danger and maximize your chances of survival. You will become conscious of this ongoing interaction with the environment only when a given need is unmet. This … Read More

Recent world events have raised a lot of questions about why would people dedicate their lives to the pursuit of destruction? My observation is that this unspeakable behavior is one of the expressions of what is learned in school that we call, “socialization”. The First Day of School Every child … Read More

Mike is a local physical therapist who is a friend of mine. He has been interested in the DOC project and, like me, has struggled with severe chronic pain. I have been helping him work through different strategies to pull out of it and he is slowly coming out of … Read More

There is a “genealogy”  of anger. It begins with a person or situation that you blame for upsetting you. You then go into a victim role and become upset. “Upset” can range from being irritated to flying into a rage. The circumstance may be real or perceived. Either way the … Read More

Patients and physicians are frequently making illogical decisions regarding spine surgery. I have watched this phenomenon steadily worsen for over 30 years. One of the core problems is that there is little accountability. You would expect your surgeon to do everything he or she could do to optimize your chances … Read More

Omega Institute, July 2015 Dr. Fred Luskin, author of Forgive for Good, my wife Babs Yohai, a professional tap dancer, and I will hold a five-day workshop at the Omega Institute in Rhinebeck, NY. The course is structured around education, hope, forgiveness, and play. It is based on the concepts presented … Read More

I was in Italy grabbing a ride to my hotel from the Florence train station. While waiting in line I noticed a slightly older taxi driver standing by his cab in the middle of the taxi stand while three or four drivers took off ahead of him. He seemed slightly … Read More

DOC (Direct your Own Care) is a framework that breaks down chronic pain into basic parts that will enable you to discover your own solution. It evolved from my own 15-year experience suffering from chronic pain with the last seven being extreme. I was fortunate to work my way back … Read More

All living creatures survive and flourish by avoiding threats and gravitating towards rewards. Humans have language and consciousness, which creates some problems with this avoidance response. Thoughts create that same chemical reaction as a physical threat and we can’t escape our thoughts. Emotional pain is processed in a similar manner … Read More

Watch the latest video at video.foxnews.com Chronic pain is at an epidemic level, affecting about a third of the adult population. In adolescents, the number of in-patient admissions rose 831 percent over a seven-year period. The reason? Many of these patients are treated for acute pain, when they are really … Read More

I had a patient come into my office many years ago who represents one of the most remarkable turnarounds I have witnessed. She definitely holds the record of being in pain for the longest time before she pulled out of it. She had been in pain for over 55 years … Read More

The Omega Institute In August of 2013 I put on a 5-day workshop at the Omega institute in Rhinebeck, NY with 11 participants. The other two faculty were Dr. Fred Luskin from Stanford and my wife, Babs Yohai, who is a professional performer (tap dancer). We designed it to address … Read More

I am noticing a pattern that seems to be quite common. People in pain control others around them – especially their close family members. I have not had the chance to research the literature but it is becoming increasingly clear how devastating chronic pain is not only to the patient … Read More

The DOC project is not a formula. You are not going to read my book and experience healing. My book is a framework that will organize your thinking. You can then systematically address all the variables that are affecting your pain. Unless you are actively learning and using the tools … Read More

Despair I will never forget a 40 year-old woman I met in the office a few years ago. She had suffered from chronic pain that enveloped almost her entire body since her late teenage years. She was anxious, depressed, and would barely lift her head to talk to me. The … Read More

This is a recent post that was on my Back in Control Facebook site.  I was well-aware that I would be on the receiving end of this type of feedback before I published the book. I deal with variations of this energy weekly. An unhappy reader “Your book about back … Read More

I first met Georgia when she was 15 years-old. She had undergone a fusion for adolescent scoliosis at another hospital. Her post-op pain was much worse than usual and nine months after the surgery she was still experiencing severe pain. Normally, pain from a fusion such as hers is gone … Read More

Power Many patients have no interest in giving up their pain. Being a victim is a powerful role – and for many is synonymous with love. Some of the reasons to remain a victim and angry are: It is a familiar pattern You are not aware or connected to your anger … Read More

  Anthony was a patient who I saw just a couple of times in his early 20’s. He was experiencing low back pain that was significantly impacting his quality of life. His MRI scan showed some mild degeneration at L4-5 and was not a problem that would respond to surgery. … Read More

When I published the first edition of my book, Back in Control: A Spine Surgeon’s Surgeon’s Roadmap Out of Chronic Pain in 2012, I was still of the mind set that if the correct pathology could be identified as the source of the pain, surgery was the best option and the sooner the better. Then … Read More

My son, Nick, has been a competitive freestyle mogul skier since he was 14 years-old. He is an extraordinary athlete and within three years of beginning his skiing career he won the Duals event at Junior Nationals. He was focused, passionate and it appeared that he was well on his … Read More

  This is Scott, who is a personal trainer that I work out with on Tuesdays and Thursdays at 6 am. This is his picture at the gym one memorable Halloween. He’s a little unusual in that he laughs at us – the whole time we are working out. He pushes … Read More

Pain, The Gift That Nobody Wants is a book written by an orthopedic hand surgeon, Paul Brand. Through his work in India with lepers he discovered that the reason why they had such severe hand, facial, and foot deformities was that the bacteria resided in sensory nerves and destroyed protective … Read More

My surgical decision-making dramatically changed over the last five years of my practice. In spite of watching so many successes of people healing from chronic pain without surgery, I still had a surgical mindset and was always looking for a surgical lesion that I could “fix”. In the first edition … Read More

Terry was a middle-aged mother of two children whom I met many years ago. For reasons that are unclear, her spine just tipped forward in her lumbar area. She came into my office severely bent forward and tipped to the left side. She had understandably developed chronic pain over the … Read More

Family Patterns Behavioral patterns laid into your nervous system are the essence of your life view. Until you become aware of them and their effect on your day-to-day life you cannot connect with the core of you really are. Being around your family usually will precipitate a massive resurgence of … Read More

Having a family member on disability is a significant risk factor for becoming disabled. For years, I was puzzled by this connection, but I saw it frequently. I learned that it is a powerful influence that centers around embedded family patterns. The initial download to your brain There are many … Read More

Omega Institute – June 7 – 9, 2019 – Relief from Chronic Pain The essence of curing chronic pain is connecting to your own body’s capacity to heal. When you are trapped by any circumstance, especially chronic pain, first your anxiety escalates and then you become angry. Your body is full of … Read More

My creative artist friend, Ernesto, endured a rough couple of years and for a while he “disappeared”. The details are not important. What is important is that he is back and thriving. This piece is a statement of his time in the “Abyss.” I spend over eight years in darkness. … Read More

Neurological circuits are permanent Pain pathways are permanent. So are the intertwined anxiety and anger circuits. I am personally reminded of this fact on a daily basis. It happened in a particularly dramatic fashion while on vacation in Italy. Florence My wife lived in Florence, Italy from 1983 to 1990. … Read More

Fourth of July fireworks I was 5 years old and lived in a small town in New Hampshire. Our house was right across the street from the town common. I was so excited in that the fourth of July fireworks were going to be launched in the common within just … Read More

Photovoltaic cells The photovoltaic cell is a solar technology that converts sunlight directly into electrical current.     Your nervous system “on the prowl” Your nervous system is designed to process all external stimuli and direct the musculoskeletal and various organ systems to respond in specific ways to maximize your … Read More

The foundation of the DOC project is understanding that pain circuits are permanently laid down in your brain quickly. It is unclear in a given person when acute pain becomes chronic, but we do know that it becomes a bigger problem after 12 months (1). The brain activity switches from … Read More

  Trying not to think about something will cause you to think about it more. All of us know this phenomenon but we don’t know how to deal with it. The deadliest emotion we suppress is anxiety. It is a survival response and our whole being is repulsed by it. … Read More

Tinnitus is an annoying (miserable) symptom that I had experienced since 1985. In another website post, The Ringing in My Ears, I tell my story about how it has all but disappeared. I was being interviewed on a radio program and somehow the topic of tinnitus came up. The host … Read More

In our society today, it’s commonly believed that the higher the opinion you have of yourself, the more confident, happy, and successful you’ll be; high self-esteem is held up as the ultimate goal. In actuality, however, this couldn’t be further from the truth: the pursuit of self-esteem is a destructive … Read More

Structuring the Own Management of Your Pain (STOMP) is a program that was developed by Dr. Gordon Irving and his staff at the Swedish Medical Center Pain and Headache Center. They have a wonderful set of resources that has greatly enhanced my patient’s capacity to become pain free. They also … Read More

A friend of mine asked me for an opinion a couple of years ago about his back. I was giving him advice as a friend, not as a surgeon. He was having some pain and numbness down the side of his leg. It was down the distribution of his 5th … Read More

Meditation is a powerful tool in calming down your nervous system, and is a skill that everyone should be taught in elementary school and continue to hone throughout a lifetime. Think what we are not taught about stress, anxiety, and frustration at an early age. A child has little control … Read More

Dr. Gordon Irving was in charge of Swedish Medical Center Chronic Pain Program for many years. His group has embraced the treatment principles of the Neurophysiologic Disorder (NPD. Although each of us have different tools and styles, the essence of our approaches is similar. One of them being you cannot … Read More

ANGER ANGEL   Love and rage are both four-letter words. A N G E   R  A  G  E A N G E L O V E The difference between the words anger and angel is one letter. What a difference a letter makes.  

The Swerve, by Steven Greenblatt is a historical account of a papal scribe’s discovery in the 1400’s of a poem, The Nature of Things. Lucretius had written it almost 1000 years earlier. He makes a case that it was the discovery of this poem that ushered the human race out of … Read More

I had a lot going on during my junior year in high school. I had left home to attend a boarding school and was free from a chaotic household. It was also incredibly stressful trying to figure out what was going on and how I fit in. In the midst … Read More

Carol is one of my favorite patients and success stories. It is one that surprised both of us. Her turnaround occurred a while back but I wanted to make sure she was stable and ready to relate her experience. Background She is a middle-aged mother. She historically had been very … Read More

The common thread of those who successfully heal from chronic pain and other symptoms of Neurophysiologic Disorder (NPD) is letting go of anger through deep forgiveness. Anger and pain are inextricably linked. For many of us forgiveness involves somewhat of an intellectual process and is focused on many small “wrongs”. … Read More

The Elephant’s Noose If you are angry, in a reactive mode, it’s difficult to develop a plan. A metaphor showing the impact of anger is how they handle elephants in India. When the elephants are very small, they train them to stay in one place by tying one foot to … Read More

STOMP Dr. Gordon Irving was the medical director of the Pain center at Swedish Hospital in Seattle, WA. He developed a wonderful set of resources for dealing with chronic pain. His version of a structured program was STOMP (Structuring Your Own Management of Pain). He and I co-edited this guide … Read More

I always ask family members or close friends to fully engage in the DOC project. It is not just for support, which is important. People exert a direct neurological effect on each other’s brains. The brain contains mirror neurons, which are cells that fire in response to the observation of … Read More

Your body under chronic stress  There are multiple physical and mental manifestations of a chronically fired up nervous system. With engagement of the principles that calm it down, the improvements in my patients’ quality of life are consistent and frequently dramatic. The foundational step continues to be the writing exercises. … Read More

I began my orthopedic surgery residency in 1981. I had an unusual path into this specialty in that I had completed two years of internal medicine residency in Spokane, WA prior to moving to Hawaii. Most orthopedic residents have had one or two years of general surgical training prior to … Read More

Bullying bothers me–a lot. When I was in middle school and high school, I was very fortunate in that I was not a target of bullying. However, I have watched dozens of friends and family come under attack from bullies. The results are often devastating. No part of bullying is … Read More

My dentist is a great guy. Our children played sports together in elementary school. Still, I tend to skip going to the dentist. I had been quite diligent for years getting my teeth checked and cleaned every six months until I got too busy and slid past a few visits. … Read More

The concept that stress can create physical symptoms has been around for centuries. In modern times we have become enamored with technology and have lost sight of the fact that multiple different physical symptoms will be caused by changes in the body’s chemistry because each organ system responds in its … Read More

Chronic pain is dangerous Chronic pain is dangerous. When you are trapped by anything in life, especially pain, you’ll become angry. When you’re angry, everything is completely about you and your efforts to escape. You can no longer see the needs of those around you, much less respond to them. … Read More

Few physicians have sufficient training in the nuances of occupational medicine, yet all of us have the capacity to completely remove a patient from the work force. It has been my observation that when a person is sitting at home, his or her pain usually worsens. Without the distractions of … Read More

Our medical and political system has failed. Employers have abused workers as long as there have been employers and workers. The intent of worker’s comp’s no-fault system was to both provide excellent medical care as well as improve worker safety. Although workplace safety has dramatically improved since the early 1900’s, … Read More

I was running an hour late in clinic and was trying to get through my last patient before my already abbreviated lunch. A young Spanish-speaking woman from Puerto Rico was lying on the table moaning. Her husband, who was sitting motionless across the room, could speak limited English, and there … Read More

Threat (perceived or real danger) creates a neurochemical inflammatory reaction (anxiety) And a need for control to escape the threat When you can’t solve the problem (trapped) Your body increases the stress response in an effort to regain control Now you are angry Anger = turbocharged anxiety Both are unconscious, … Read More

Caroline Myss-Taking Back Your Spirit Anger and chronic pain are linked pathways. It is not possible to release yourself from your pain and move foward with your life until you can experience true forgiveness for the people who have wronged you the most. This remarkable video was passed on to … Read More

I had been working with Anne for a while and she had been experiencing chronic pain throughout her body for a many years. Her once productive life had fallen apart and she now depended on welfare for her sustenance. She had undergone a lumbar disc surgery a couple years earlier … Read More

One of the core concepts of the human condition is labeling experiences, trends, groups or people. It comes along with having the capacity to communicate through language. Yuval Noah Harari in his book, Sapiens, pointed out that the cognitive revolution for Homo Sapiens occurred about 70,000 years ago with the advent of … Read More

Dr. Howard Schubiner is board-certified in pediatrics, adolescent medicine, and internal medicine. He was a full time professor at Wayne State University for 18 years and now works at Providence Hospital in Southfield, MI. He is the founder of the Mind Body Clinic and the co-author of several of my … Read More

I am a strong supporter of psychology, psychiatry, and any mental health profession that can provide insight into how to live a full and productive life. However, I want you to think differently about mental health for a moment. Consider it not in terms of talk therapy but in terms … Read More

Almost every patient of mine who is in chronic pain is also experiencing much adversity in the rest of his or her life. Chronic pain rips through every aspect of your life and there is no apparent escape. The stories I hear each day are mind-boggling. They include abuse, murder, … Read More

It is an almost universally held belief among surgeons and patients that a specific structural lesion is usually the cause of pain. If that lesion can be identified and repaired, the pain will abate. This seems plausible. A diagnostic test ought to be able to identify the source of intense … Read More

Pain is a perception that is affected by many factors. Our western medical culture has focused on the idea that there is always a direct physical source or “pain generator” that can be identified and fixed. You are Not a Machine “Pain-Generator” thinking takes the human body to be like … Read More

I don’t recall much about learning how to ride a bicycle. I remember the training wheels and taking a few nasty falls. I do know that my father wasn’t there to help me or witness it. He was a small town family doctor who routinely worked over a hundred hours … Read More

A letter from a case manager Dear Dr. Hanscom: You may not receive these kinds of letters from nurse case managers very often. I thought I would advise you of the above captioned patient that you performed a redo L5-S1 microdiscectomy about a year ago.  Ron got quite discouraged when … Read More

When I began to witness patients becoming pain free, I thought that it would happen only for patients with diffuse pain, such as neck or back pain. I felt that more focal symptoms like arm and leg pain would not respond as well. I was wrong. I now have many … Read More

Crystal is a woman from the southern part of Washington. When I first met her, she was over 70 years-old and lived on her own. She had severe spinal stenosis in her lumbar vertebrae at multiple levels. Stenosis is a condition where bone and ligaments grow around the spinal canal … Read More

It has become clear that if a given patient engages in the principles outlined in this book, he or she has a high chance of experiencing a dramatic decrease in pain and improved quality of life at some point in time. The richness of this new life often exceeds anything … Read More

Mental Health Every injured worker should have access to some level of mental health support. I work with a veteran pain psychologist who is wonderful. 90% of her practice is caring for my patients. If she feels it is necessary, she will refer a patient to one of several psychiatrists … Read More

  Abraham Maslow Abraham Maslow (1908-1970) was a brilliant professor of psychology. He founded a branch of psychology known as “Humanistic Psychology,” which focuses more on psychological virtues or excellences rather than on psychological disorders. Maslow is best known for his conceptualization of “man’s hierarchy of needs.” This hierarchy is … Read More

Self esteem involves endless judgment of comparing yourself to others around you. I discuss the negative impact that this concept has on us. For more, see The Myth of Self Esteem.  

I talk about how anxiety and stress can lead to certain obsessive tendencies. Some of the tools from the DOCC project are laid out, specifically those that can help break down the circuits that fuel anxious and stressful thoughts and behaviors. For more, see Your Demons are Robots. BF

Behavioral patterns laid into your nervous system are the essence of your life view. Until you become aware of them and their effect on your day-to-day life you cannot connect with the core of you really are. Being around your family usually will precipitate a massive resurgence of these patterns. … Read More

A few weeks ago, I sent the roundtable a short article I put together called “Ability and Motivation.”  These are the two key ingredients necessary to create true change. My point was that the current state of the worker’s comp system destroys both of these attributes.  The only logical choice … Read More

All of us know we can’t think clearly when we’re upset. There’s a physiological reason why. Adrenaline and other stress hormones will diminish the blood supply to the frontal lobes of your brain.The flight or flight response is ONLY about survival and that’s it.   REACTIVE CREATIVE If you can … Read More

Stimulating your brain to form new circuits first involves awareness of what already is, separating or creating some space between the stimulus and response and then redirecting your attention. Visualization is an effective method to create new pathways around your embedded pain pathways. Part of the chronic pain experience is … Read More

I talk about how the suppression of negative thoughts associated with chronic pain can really fire up the nervous system.  Dr. Daniel Wegner from Harvard published an elegant paper in 1987 demonstratng the impossibity of trying to suppress thoughts. I’ve talked about it before in White Bears and ANTS.   BF

Roy Carey, a well respected spinal surgeon in Melbourne created this video highlighting the decision-making about undergoing spine surgery. It helped reduce the frequency of spinal surgery in Victoria, New Zealand.  

I discuss how anger is the turbocharger that keeps anxiety both covered up and fired up. Until you turn off anger you won’t be able to get a handle on your anxiety or your pain.  

I talk about how powerful the DOCC Project can be and how it can break down the doors of years of chronic pain. Through patient’s stories, the DOCC project is showing that pain free is not only possible, it’s probable. For more on this, check out Reversing Chronic Pain with … Read More

I am a busy spine surgeon, yet I spend most of my time talking my patients out of surgery. When I do recommend surgical treatment, many, if not most, become apprehensive. They have heard that spine surgery never works and will relate stories to me about their friends, family, or … Read More

Our brain has neurological circuits that can become memorized. In this video I discuss phantom pain, which is more the rule than the exception with amputations. This factor is a significant problem with any chronic pain situation.

Compassion—First and foremost I am on a much-needed vacation this week in Italy.  From 1980 until 1990, my wife lived in Florence.  We have many friends in Italy we like to visit as much as we can.  It is a unique opportunity for me in that she is fluent in … Read More

I discuss how the brain becomes more sensitive to pain with repetition. I also introduce the first 3 “E’s” of the 5 “E’s” of chronic pain as well as the evolution of pain. The 5 “E’s” are Empathy, Evaluation, Education, Encouragement and Engagement. For more on this, check out Sensitization … Read More

I discuss the cultural belief system about spine surgery and it’s impact on the treatment for chronic pain. It took me years to understand that performing fusions for LBP is based on unsubstantiated belief rather than hard data. I thought that surgery could always alleviate pain and felt I had an … Read More

  “Happy” We all want to become better, happier people, and we work pretty hard at it. The marketing world keeps reminding us that we are not even close to our potential and holds up endless images of perfection that reinforce that idea. The solution advertising offers is a better … Read More

“It is not true that people stop pursuing dreams because they grow old.  They grow old because they stop pursuing dreams.” Gabriel Garcia Marquez “It is not true that people stop pursuing dreams because they grow old. They stop pursing dreams when they are crushed by relentless anxiety… Gabriel Garcia Marquez … Read More

I look at the source of the pain and it’s receptors in reference to back pain and one’s spine. I also discuss the difference between a structural and non-structural source of the pain. Read more about this topic in discussing structural sources of pain.  

I was raised in a chaotic household. My mother was physically and emotionally abusive. It was confusing for me to feel like I had a mother who would do anything for her family and then, within seconds, watch her unpredictably fly into a rage lasting several days. From a young child’s … Read More

I talk about the importance about finding the “source” of the pain and the implications of the “real” success rates of most spine operations. This clip takes a closer look into back fusions and the research behind them. Learn more about this in my post, “Surgical Results Overly Optimistic.” Aching … Read More