Solving/ Preventing Chronic Disease – Mental and Physical
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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

My Descent Into The Abyss
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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

Dynamic Healing
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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

Stress Kills – Threat versus Safety
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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

Let’s Start Now and Learn the Details Later
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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

The Myth of MUS (Medically Unexplained Symptoms) – It’s MES
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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

Become a Genius at Not Feeling Pain
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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

Directly Calming Your Body’s Threat Response
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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

Principles of Solving Chronic Pain
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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

Essence of Illness
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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

A Physician’s Story of Healing
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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

Clarifying the New IASP Definition of Chronic Pain
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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

Anxiety is the Correct Name for Pain
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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

Reprogram your Brain Around Pain
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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

Smell the Peppermint–Safe or Unsafe
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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

This COVID-19 Pandemic is Solvable–NOW
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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

Evolution of the DOC Project
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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

Anxiety is a Symptom – Not a Diagnosis
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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

Depression is Anxiety
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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

Pain Sensitization – A Frayed Wire
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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

My Cat has Irritable Bowel Syndrome?
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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

Anxiety Basics
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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

A Viable Solution for the Opioid Epidemic
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  The solution to the opioid epidemic is to solve chronic pain. 87% of patients on opioids have chronic pain (1), which is both driven by and results in severe anxiety. The second aspect of dealing with it involves recognizing that what drives most people to use opioids is mental pain and … Read More

Married 40 years – What Worked?
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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

Darkness – “The Abyss”
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Objectives: Appreciating the depth of suffering experienced when trapped by chronic mental or physical pain is an important early awareness that will allow you to begin to move forward. You feel extremely isolated but everyone in this hole is also suffering badly. You are not alone. The factors that make … Read More

The Magic of Medical Hypnosis
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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

Healing Begins at Home – The DOC Journey Starting Point
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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

My Story of Hope
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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

Verbal “Expressive Writing”
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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

Begin Your Healing Journey at Home
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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

More on Expressive Writing
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“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

OCD is No Fun and Not Funny – Extreme Mental Pain
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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

Not Sharing Your Pain – Omega
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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

Sharing My Pain
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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

“This is going to hurt”
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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

Solve Chronic Pain – Listen
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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

Neurophysiologic Disorder
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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

Anxiety
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  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

Understand Chronic Pain
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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

C – Neurophysiologic Disorder (NPD)
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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

Back in Control – Second Edition
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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

Systematic Approach to Sleep
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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

Societal Disintegration – Untreated Anxiety
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Relentless untreated anxiety is the core driver of destructive human behavior. Anxiety is simply the sensation generated by your body’s stress chemicals in response to a mental or physical threat. It is not primarily a psychological issue and is the mechanism that permits survival of any living creature. Species that … Read More

Neurophysiological Basis of Pain
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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

Taking Charge of Your Care
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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

The Pain of Social Isolation
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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

Fighting a Forest Fire – Address All Aspects of Your Pain
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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

Introductory DOC Concepts
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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

Anxiety, Anger, and Adrenaline
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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

Write Your Way Out of Chronic Pain
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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

Stress, Illness, and Photovoltaic Cells
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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

Thought Suppression and Chronic Pain – White Bears and ANTS
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  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

Embracing Adversity – Tinnitus
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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

Physical versus Emotional Pain
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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

Healing Power Within—Warts
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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

The Ringing in My Ears – Tinnitus
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Posted in: Stage 1: Step 1 The old saying, “Youth is wasted on the young,” is true—especially in my case. Many of the physical issues of my adulthood resulted from a perceived invincibility during my teenage years, combined with my refusal to heed adult advice. Protecting my ears was one of … Read More

Mold Your Brain: Neuroplasticity
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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

Unhooking from the Train
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Neurophysiological Disorder? The multiple manifestations of the Neurophysiologic Disorder (NPD) endlessly fascinates me. With engagement of the principles that treat it, the improvement in my patients’ quality of life is consistent and frequently dramatic. The foundation of success continues to be the writing exercises. I don’t know the reasons why it is … Read More

My Feet on Fire
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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

Charley’s Story: Pain Free After 17 Doctors
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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

My Midnight Trip to the Dentist
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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

My Battle with NPD
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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

Your Hand Stuck Over the Stove
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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

Freed by a Pen
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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

Marsha’s Three Unnecessary Spine Surgeries
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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

Neurophysiological Disorder -“Short Circuits”
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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

A – Structural Sources of Pain
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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

You are Not a Machine
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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

Unlearning How to Ride Your Bicycle
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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

Video: Anxiety and It’s Demons
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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

Video 16/19: “White Bears”
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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

“The Talent Code” – Forming Neurological Pathways
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All pain is “in your head.” Every pain impulse has to be interpreted by your brain as pleasant, neutral or unpleasant. It is a complex process that involves comparing present with past experiences. There are millions of bits of information being processed every second. Although your emotions do affect the … Read More

Back Pain vs. Mouth Pain
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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

Video: Memorizing the Circuits: Phantom Pain
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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.

Video: Your Brain Becomes Sensitized
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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

Video: Is Your Pain Structural or Not?
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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.

A Bunch of Balloons
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Much, if not most, of what the DOC project presents about creating a central nervous shift is 180 degrees different than how most of us are taught to deal with our conscious mind. One of the most important paradoxes to understand is that you cannot fix your nervous system because … Read More

Video: Introduction of David Hanscom
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In this introductory clip, I lay out my novel approach to chronic pain. In addition to sharing some of my personal experience in spine surgery, I give insight into how my approach to spine surgery and the overall care of my patients has developed and progressed.

David Burn’s Letter
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In the beginning of the DOC Project, the only resource that I had for my patients to deal with the stress of pain was the Feeling Good book. I discovered that patients would often notice significant improvements in their pain and mood within a few weeks. Historically, I could not … Read More

Motivated by “The Talent Code”
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Dear Dr Hanscom, Having read (devoured actually) The Talent Code by Daniel Coyle, I can now share with others the benefits I received through reading this book. The author demystified that very mysterious quality of world-class excellence. He teaches that through deep practice, anyone can train themselves (and hence their … Read More

The Terrifying Triad
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When a basic human need such as air, food, or water is not met, we experience a deep feeling of anxiety.  We then take directed action to meet the need, which allays our anxiety. When the ability to meet our basic needs is taken from us, our anxiety escalates to … Read More

Write and Don’t Stop!
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  There are over 1000 research papers that document that expressive writing in some form is effective for improving both your mental and physical health. I have been adamant for a long time that you should write down just negative thoughts – not positive ones. That has also been the … Read More

Your Demons are Robots
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It is critical to understand how deeply negative anxiety-producing thoughts are etched into your nervous system. A 1987 Harvard experiment (1) documented that when you suppress unpleasant thoughts, they become more powerful. Unfortunately, they documented a trampoline effect in that they become much stronger. Thought suppression Disturbing thoughts are universal. When … Read More

Normal Arms Amputated
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It’s important for you to understand how powerfully and quickly pain circuits are embedded into the nervous system. It’s accomplished in the same way one learns anything—by repetition. Pain impulses flood your brain much faster than and athlete, artist or muscian a learned skill of an athlese more numerous than … Read More

Degenerative Disc Disease Isn’t a Disease
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Surgeries being performed for axial neck, thoracic, and low back pain on normally aging spines was a major reason I quit my spinal surgery practice in 2019. Not only was the success rate low, patients were often much worse after the surgeries and few physicians were willing to take care … Read More

Decreasing Anxiety with Control
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Anxiety is the basis for most of our behavior and ability to stay alive. We have many cues around us that govern our actions so as to avoid danger. The essence of this sequence is: 1) a circumstance causes anxiety 2) we control our actions or the situation to alleviate … Read More

Sleep Disorders
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Only five percent of patients have an adequate evaluation of their sleep issues by any physician. (1) This is unfortunate, because lack of sleep is such a common problem. The term commonly applied to trouble getting a good night’s sleep is insomnia, but there are over one hundred sleep disorders. … Read More

Writing at Bedtime
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When you are under stress, your brain is on a Formula One racetrack.  Being in chronic pain is one of the most miserable experiences of the human existence. There is hardly any strategy that will slow down your racing thoughts during the day, and it becomes much worse at night … Read More

Sleep Meds
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Nothing can really happen in the context of the DOC Project until you are regularly getting a full night’s sleep. Exhaustion makes it impossible for anyone to concentrate long enough to engage in the program. For anyone with chronic pain, this probably sounds impossible. You may think, how can I … Read More

Sleep Hygiene
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Sleep hygiene is a term that’s used to describe a group of strategies that will improve your ability to get a restful night’s sleep. In the context of chronic pain, these strategies often need to be supplemented with medications, but they are nonetheless important.     It’s your first priority … Read More

B – Non-Structural Pain
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Patients often wonder how soft tissues can be so painful. It’s because they have a high density of pain receptors arranged in a spider web type pattern. These irritated soft tissues give rise to some of the most painful conditions such as plantar fasciitis, tennis elbow, muscular tension headaches, chondromalacia … Read More

“Feeling Good” format
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After you have become comfortable with writing down and immediately destroying your thoughts, the next phase involves the “three-column technique that Dr. David Burns outlines in his book, Feeling Good. It provides an excellent format in which to apply the principles of cognitive behavioral therapy in a self-directed manner. I personally … Read More

Anger
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Anger is as important as anxiety when it comes to chronic pain management. Some people are able to come to grips with anger and process it in a healthy way. For others, a lack of control over anger erodes their quality of life.  Forget about physical pain for a moment. … Read More

Sleep
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Understanding the importance of sleep and its effect on the perception of pain was my initial insight into the neurological nature of chronic pain. Incorporating adequate sleep into my treatment of pain was my first step in the evolution of the DOC Project. I felt I had a whole new … Read More

4 – The “Modifiers”
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There is a sequence of events that results in chronic pain. It is complex and not linear. The first step is to acknowledge a source that can originate from soft tissues, a structural abnormality, or the brain can “short circuit” and spontaneously generate pain. It is also critical to understand … Read More

Masking
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Masking your reaction to stress is a way of dealing with repetitive racing thoughts. Masking is behavior that’s used to cover up uncomfortable emotions. Driven by anxiety, you do something to get you mind off of a negative situation. It can be effective if used correctly, but it’s usually not … Read More

Suffering
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  Repetitive thoughts When you suffer, you have the same set of thoughts over and over; a process that clearly reinforces a given neurological circuit. Suffering takes many forms. Ways it is manifested include complaining, arguing, manipulation, gossiping, etc. There are often strong repetitive thoughts regarding the mess that your … Read More

3 – Memorization of Neurological Circuits
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Memorization of neurological circuits is the another phase of the chronic pain experience in addition to pain sensitization. The way you learn any skill, such as a sport or musical instrument is repetition. It takes years of focused practice to attain the highest level of competence in a given field. … Read More

Early Sleep Concepts
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I learned about the importance of sleep somewhat by chance. It was covered in my medical training. I read a book, The Promise of Sleep.  It was an autobiography of William Dement, who started the first sleep lab at Stanford. I became interested in the effects of sleep on chronic … Read More

DOC – A Framework of Care
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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. The DOC (Direct your … Read More

2 – Sensitization to Pain
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I frequently encounter patients who feel that there must be an anatomical problem that is progressing as their pain is getting worse.  There has been no further injury.  Nonetheless, these patients become even more focused on finding the problem and having it surgically fixed. I am extremely committed to not … Read More

The Evolution of Chronic Pain
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Objectives: Understand the complexity of chronic pain and how it evolves from acute to chronic. The factors to consider are the source, sensitization, memorization, and the “modifiers” of anxiety, anger, and sleep. Breaking chronic pain into its component parts allows them all to be systematically addressed and it becomes a … Read More

1 – Three Sources of Chronic Pain
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Dr. Howard Schubiner Dr. Schubiner is a pain physician practicing in Detroit, MI. He approaches pain from a whole body perspective. I consider him one of my major mentors and was the one who unlocked the door to cause of all my unexplained symptoms. I asked him to explain how … Read More