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28 Surgeries–”I elected to not be in pain”

For many years, I thought that for many patients there was a point of no return because the sheer magnitude ...

Science has the Answer to the Opioid Epidemic – Is anyone listening?

The Federal government has spent billions of dollars on combating the opioid epidemic. In 2022, 1.5 billion dollars was allocated ...

With every word I release, I free my heart and return to myself.

Expression Pain has a way of becoming a quiet tenant—settling into the soft chambers of the mind, curling into the ...

Suicide – A Horrible Way to Escape from Pain

Objectives The root cause of suicide is feeling trapped and mental and physical pain are problematic.significant reasons to feel this ...

Be Heard to Heal

You must understand the nature of a problem before you can solve it. It is well-publicized that over 100 million ...

Evolution of the DOC Framework

DOC beginning The DOC (Direct your Own Care) program evolved after I discovered that, through a systematic approach that addressed ...

Begin Your Healing Journey at Home

It has become increasingly apparent to me that chronic pain is a family issue. Your deepest human interactions happen at ...

Honoring Loss by Living

Objectives: Life is full of loss and unfulfilled wishes. Sehnsucht is intense regret. Stress of a deep loss can trigger ...

Create a Safe Haven – Family

Pain = Frustration. In the presence of unrelenting pain this frustration can be intense. Anger is a survival reaction and it ...

Let’s Wake Up

Overview Our conscious brain interprets our internal bodily sensations. Since we are geared to survive, most of our time is ...

The Gift of Pain – Thanksgiving 2013

Pain, The Gift That Nobody Wants is a book written by an orthopedic hand surgeon, Paul Brand. Through his work ...

“I Want to Believe”

Florence, Italy My wife lived in Florence, Italy from 1983 to 1990. She is fluent in Italian and some of ...

Stage 1 - Lay the Foundation

Select a step from the dropdown menu below to view the posts in that step. The steps are:

Step 1 - Learn About Your Pain
Step 2 - Expressive Writing
Step 3 - Active Meditation
Step 4 - Sleep
Step 5 - Don't Share Your Pain

More on Expressive Writing

“I am the biggest ever skeptic. But I thought what the heck. My lower back pain has been very bad ...

Extreme Mental Pain – OCD

Obsessive Compulsive Disorder (OCD) is an extreme form of anxiety. A relentless assault of unwelcome intrusive thoughts characterizes it. I ...

Not Sharing Your Pain – Omega

I have held several three and five-day workshops in Rhinebeck, NY at the Omega Institute with Dr. Fred Luskin, a ...

Sharing My Pain

One of the tenets of successfully solving chronic pain is to stop discussing your pain with others. Dwelling on your ...

“This is going to hurt”

Your experience of pain depends on many parts of your brain receiving a signal, and comparing it to your expectations ...

Neurophysiologic Disorder

There have been numerous terms used to describe the body’s response to chronic stress and the physiological response. The original ...

Anxiety

The ability to process anxiety in a healthy way is critical to maintaining your quality of life. It is even ...

Understand Chronic Pain

There are two fundamental aspects to the perception of pain: The source: Three Sources of Chronic Pain Possible structural problem ...

C – Neurophysiologic Disorder (NPD)

There have been numerous terms used to describe the body’s response to chronic stress and the physiological response. The original ...

Back in Control – Second Edition

The second edition of Back in Control: A Surgeon’s Roadmap Out of Chronic Pain will be available November 17th, 2016 ...

Systematic Approach to Sleep

Objectives: Adequate sleep is a necessary requirement for healing. Insomnia is a cause of chronic pain, and it is not ...

Neurophysiological Basis of Pain

To say that the wave of mass shootings over the last few years is disturbing would be grossly understating how ...

Taking Charge of Your Care

I want to share an email I received from a colleague regarding the effect of the DOC (Direct your Own ...

Fighting a Forest Fire – Address All Aspects of Your Pain

Objectives: Chronic pain is a complex multi-organ disease. It is reason why there are so many different symptoms. It cannot ...

Introductory DOC Concepts

DOC (Direct your Own Care) is a framework that breaks down chronic pain into basic parts that will enable you ...

Anxiety, Anger, and Adrenaline

All living creatures survive and flourish by avoiding threats and gravitating towards rewards. Humans have language and consciousness, which creates ...

Stage 2 - Forgive and Play

Select a step from the dropdown menu below to view the posts in that step. The steps are:

Step 1 - Understand the Impact of Anger on Your Life
Step 2 - Acknowledge Your Disguises
Step 3 - Admit Your Victimhood
Step 4 - Choose Not to Remain a Victim
Step 5 - Forgive
Step 6 - Play

Awareness, Hope, Forgiveness and Play

These four elements form a powerful alliance to connect to your own capacity to heal, which is the essence of ...

The “Benefits” of Becoming Disabled

I have always enjoyed hard work. I began working in heavy construction at age fourteen during the remodeling of our ...

Stress and Getting Sick – Howard’s Golf Story

For those of you who are golfers, you know that golf is a great metaphor for life. It is both ...

Changing Your Story – Reframing

Neuroplasticity is the term for the brain’s capacity to physically adapt to the environment. This is modulated by sensory input ...

Aced Out

I received an email from an orthopedic colleague who I have never personally met. We are both part of an ...

Your Personal Brain Scanner

Every second of your life depends on your brain scanning your surroundings for trouble. This unconscious process guides your behavior ...

The Power of Pain

Recent world events have raised a lot of questions about why would people dedicate their lives to the pursuit of ...

Rewire Your Brain – Omega 2015

Omega Institute, July 2015 Dr. Fred Luskin, author of Forgive for Good, my wife Babs Yohai, a professional tap dancer, and ...

“The Unenforceable Rules”

I was in Italy grabbing a ride to my hotel from the Florence train station. While waiting in line I ...

Ready to Blossom – Omega 13

The Omega Institute In August of 2013 I put on a 5-day workshop at the Omega institute in Rhinebeck, NY ...

“But You are Still Angry”

The DOC project is not a formula. You are not going to read my book and experience healing. My book ...

Destroyed by Bullies

Despair I will never forget a 40 year-old woman I met in the office a few years ago. She had ...

Your Book is Bullshit – The Encompassing Power of Anger

This is a recent post that was on my Back in Control Facebook site. I was well-aware that I would ...

Violence and Love

Power Many patients have no interest in giving up their pain. Being a victim is a powerful role – and ...

Nick’s Winning Run – Off of the Hill

My son, Nick, has been a competitive freestyle mogul skier since he was 14 years-old. He is an extraordinary athlete ...

“The Cup Song”

Omega Institute – June 7 – 9, 2019 – Relief from Chronic Pain The essence of curing chronic pain is connecting to ...

Stage 3 - Move Forward

Select a step from the dropdown menu below to view the posts in that step. The steps are:

Step 1 - Commit to a Daily Practice
Step 2 - Create a Safe Haven - Family
Step 3 - Get Organized
Step 4 - Connect with the Life You Want
Step 5 - Create Your Vision

A Couple Re-united

During the last few years of practice, our team became extremely aware of the effect of chronic pain on the ...

Listen to Your Family–No Advice or Criticism

“I am asking you to not give ANY advice to any member of your family for the next month and ...

A Safe Haven – Omega 2018

Our next weekend workshop will be held this summer at the Omega Institute in Rhinebeck, NY. The dates are Friday ...

Why are New Year’s Resolutions So Hard to Keep?

Each new year, many of us spend time figuring out how we’ll make it better and also to really complete ...

Happily Ever After

My wife and I were at a wedding this weekend. The bride was the daughter of some of our closest ...

The Impact of Mirror Neurons

It is becoming increasingly clear that chronic pain has a tremendous impact on your immediate family. One of the more ...

The Taste of Freedom – Omega 2017

Becoming socially isolated often occurs when suffering in pain. Additionally, the area of the brain that lights up is similar ...

Your “Identity” Can Destroy You

Humans spend a good part of their life energy creating and maintaining something called “self-image.” Thanks to parents, peers, and ...

The Chronic Pain Marriage-Go-Round

I have long asked the spouses/ partners of my chronic pain patients to participate in the DOC project (“Direct your ...

The Two Faces of Christmas

Louis Cozolino, in his exhaustive book The Neuroscience of Human Relationships, points out that that human consciousness developed through interacting ...

Moving Forward with Your Pain

Moving Forward with Your Pain Objectives Most of us are under the impression that you must first solve your chronic ...

Be All that You Can Be – or Just Be

Objectives Modern civilization offers more opportunities than any other era of human history. Yet our mental health is declining. We ...

The Essence of the DOC Process

“The essence of the DOC process is simply chilling out and moving on. One cannot happen without the other. This ...

Take Back Your Life

Whenever your peace of mind is at the mercy of your external circumstances, you are at the mercy of them ...

Happy Father’s Day – Not

I was landing in Salt Lake City to spend Father’s Day weekend with my son and daughter-in-law. While standing at ...

Pain Rules the Roost

I am noticing a pattern that seems to be quite common. People in pain control others around them – especially ...

Stage 4 Posts - Expand Your Consciousness

Select a step from the dropdown menu below to view the posts in that step. The steps are:

Step 1 - Pass Through the "Ring of Fire"
Step 2 - Step Into Your New Life
Step 3 - "Failing" Well
Step 4 - Look Up - Your Spiritual Journey
Step 5 - Giving Back is Healing

The KKK and a Spiritual Journey

I am a strong supporter of psychology, psychiatry, and any mental health profession that can provide insight into how to ...

The First and Last Day of School

“It is not true that people stop pursuing dreams because they grow old. They grow old because they stop pursuing ...

Video: Standard Stress Skills Inadequate

I talk about how the DOC Project can relate to other aspects of our everyday life, including everyday stressors and ...

Plugging the Negative Drain

Picture yourself in a tub trying to fill it to take warm, relaxing bath. The drain is not only wide ...

My Hoffman Experience

Hoffman is a seven-day residential personal growth experience where you are able to become aware of your family patterns of ...

Hoffman Process

Hoffman Institute The headquarters of the Hoffman Process is located in Rafael, CA. They offer the process in the US ...

Stage 5 - Decision-making

Select a step from the dropdown menu below to view the posts in that step. The steps are:

Step 1 - General Principles - The Grid
Step 2 - The Source of Your Pain
Step 3 - The Impact of Stress on Your Pain and Decision-making
Step 4 - Understanding the Magnitude of the Surgery
Step 5 - Making the Final Surgical Decision
Step 6 - Stories of Surgical Despair

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Stage 6 Posts - Procedures

Select a step from the dropdown menu below to view the posts in that step. The steps are:

Step 1 - General Considerations: Magnitude vs. Benefit
Step 2 - Decompressions
Step 3 - Lumbar Fusions
Step 4 - Deformity Surgery
Step 5 - Other Spine Surgeries
Step 6 - Stories of Surgical Despair

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Important Posts

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Stories of Hope

My Feet on Fire

I began my orthopedic surgery residency in 1981. I had an unusual path into this specialty in that I had ...

“I Am Not Letting Yesterday Ruin Today”

I had been working with Anne for a while and she had been experiencing chronic pain throughout her body for ...

Ron Salvages His Own Spine Surgery

A letter from a case manager Dear Dr. Hanscom: You may not receive these kinds of letters from nurse case ...

A New Life at 72

Crystal is a woman from the southern part of Washington. When I first met her, she was over 70 years-old ...

Bipolar Disorder Broken

Debbie was a 45 y/o woman who I had been working with for about four years. She was diagnosed with ...

Expressive Arts Gallery

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Other Posts

Repetitive Unpleasant Thoughts

Click a Show Section button below to view the posts in that section.

Section 1 - Overview of RUTs

Overview of RUTs

RUTs - Defining the Problem

“The Curse of Consciousness” – Trapped by Your Thoughts

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 ...

Quit Fighting Darkness and Turn on the Light

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 ...

Am I Operating on Your Pain or Anxiety?

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 ...

My Descent Into The Abyss

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 ...

Section 2 - Solving RUTs

Solving RUTs

Separating Your Identity from Your Physiology

The Gift of Anxiety – Your Bodyguard or Prison Guard?

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 ...

Four Aspects of Solving RUTs

Objectives Mental and physical pain are processed in similar regions of the brain. Our inability to escape from RUTs relentlessly drives flight or fight physiology, and people may become ill. There is a healing sequence for solving them: separation of ...

The Popcorn Machine – Healing RUTS

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 ...

Write and Don’t Stop!

There are over 2200 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 ...

Unhooking from the Train

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 ...

The Three Column Technique

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 ...

Active Meditation

A basic tenet of many Eastern philosophies is that worrying about the future and thinking about the past causes internal unrest. There is anxiety around the future and many regrets and frustrations about the past. By staying only in the ...

Anger Academy

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 ...

Directly Calming the Threat Response

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 ...

“5–3–2” – Processing Anger in Three Steps

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 ...

RUTs – Can’t Take Your Hand Off the Stove? Turn Down the Heat

Holding your hand over a hot burner triggers an immediate threat response (anxiety) and prompts action to address that threat. This sequence is part of the protective pain response known as the nociceptive pain system. Numerous danger cues activate this ...

Quit Fighting Darkness and Turn on the Light

Section 3 - The Evolution of RUTs

The Evolution of RUTs

The Need for Mental Control – The “Ironic Effect”

Your Demons are Robots

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 ...

Your “Authentic Self”

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 ...

Your Personal Brain Scanner

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 ...

Threat versus Safety Physiology

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 ...

Common Links to Chronic Disease – RUTs are Relentless

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 ...

We have no protection from mental pain

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 ...

Section 4 - Consequences of RUTs

Consequences of RUTs

Clinical Manifestations / illnesses/ Diseases

Extreme Mental Pain – OCD

Obsessive Compulsive Disorder (OCD) is an extreme form of anxiety. A relentless assault of unwelcome intrusive thoughts characterizes it. I suffered from OCD for several decades, well before I knew what OCD meant. It is becoming increasingly apparent that many ...

School or Prison – What’s the Difference?

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 ...

Threat Physiology Can’t be Controlled with Behavioral Approaches

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 ...

School or Prison – What’s the Difference?

Threat Physiology Can’t be Controlled with Behavioral Approaches

Section 5 - Healing Principles

Healing Principles

Addressing RUTs

The “C”quence of Healing Chronic Illness

Objectives Connecting to every aspect of your life is difficult but is essential for allowing your body to heal. “Being” with your past may be challenging, but it is necessary in order to learn and grow. It is the opposite ...

Your “Authentic Self”

Navigating Life is Similar to Playing Major League Baseball

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” ...

Become a Genius at Solving Pain

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 ...

Repetition and Healing

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 ...

“She Just Let Go”

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 ...

A Bunch of Balloons

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 ...

Let's Wake Up

Falling in Love

Remember the first time you fell in love? Maybe you had a crush on a classmate in sixth grade. What about your first true love and being head over heels to the point you felt you couldn’t live without them? ... Read More

Honoring Loss by Living

Objectives: Life is full of loss and unfulfilled wishes. Sehnsucht is intense regret. Stress of a deep loss can trigger chronic pain, and there is nothing you can do. Remaining attached to your trauma prolongs the pain. Live your life ... Read More

Let’s Wake Up

Overview Our conscious brain interprets our internal bodily sensations. Since we are geared to survive, most of our time is spent in survival physiology. In this state, blood flow shifts away from our highest thinking brain, and we react more ... Read More

Overview of RUTs

RUTs - Defining the Problem

Solving RUTs

Separating Your Identity from Your Physiology

Four Aspects of Solving RUTs

Thought Diversion

“Turn Down the Heat” – Anger

Nurturing Creativity

The Evolution of RUTs

The Need for Mental Control – The “Ironic Effect”

We are brainwashed by our life experiences

The Physiology / Mental Mechanics

Consequences of RUTs

Clinical Manifestations / illnesses/ Diseases

Behaviors Driven by RUTs

Punishment Can’t and Won’t Stop Destructive Behaviors

Healing Principles

Addressing RUTs

Becoming a Professional at Living Life

“Letting Go” – Freedom from Mental and Physical Pain