Moving Forward with Your Pain

“Life is like riding a bicycle. To keep your balance, you must keep moving forward.”

Albert Einstein

The goal of the DOC process is not to get rid of your pain. In fact, there is no goal at all. There is no beginning or end to it. The only intention is to live your life fully with the deck of cards you have been dealt – with or without your pain. You have to keep moving forward to move through your pain.




It would be nice to be free of pain but it would also be great to have more money, enjoy prestige and power, be able to dunk a basketball, be a rock star and the list is endless. If you are waiting for your pain to disappear before you engage in a full life, your pain is still running the show.

Understandably, everyone wants to be free of pain. But that isn’t life. The brain treats emotional and physical pain in a similar manner and the body’s physiological response is the same. So even you were to be rid of your physical symptoms the quality of your life would not change as much as you might think. The emotional circuits will keep firing in response to day-to-day stresses. Am I operating on your pain or anxiety?

I used to think that if I surgically solved a specific severe symptom in a patient with chronic pain, the degree of relief would be so compelling it would propel him or her back into a full life. (1) I could not have been more wrong. Unrelenting anxiety, which drives chronic pain, is intolerable and it does not improve, even if it was originally generated by a structural problem. What is disturbing is that another body part will frequently light up. (2) I am reminded of this issue every week.

So if you can’t fix yourself and there is no “goal”, what can you do? The patients who are successful in regaining their lives just move on – with or without their pain. A bunch of balloons Paradoxically, there is a much higher chance they will leave it behind. One metaphor is that of diverting a river into a different channel. Your brain will develop wherever you place its attention. There are many ways to re-direct. Some of them include:

The unwinnable battle

Doing battle with pain places neurological attention on the pain pathways. It is similar to being caught in a Chinese finger trap. Awareness allows you to choose to first push your fingers together and gradually escape


 A friend of mine, who may have been the first DOC success in 2006 just sent me this email that suggested a different take on visualization.

Hi David,

Great quote from your latest post:

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

Gabriel Garcia Marquez

To your quote about anxiety crushing dreams and the ability of dreamers therein, I’d add that pushing through the anxiety and daring to dream, regardless of how you feel, creates an inverse effect of calming the anxiety, because sometimes, just having something to believe in, as simple as that, takes us out of our anxiety momentarily enough to see clearly, and thus move forward to a better place. It works for me as a visualization tool to break the “anxiety cycle” as I call it. And if someone doubts this protocol, they only need to buy a lottery ticket. For the cost of $1, you walk out of that store and start visualizing what you’ll do with the money, and in that very moment, you’re not anxious. Instead, you find yourself, calming, your breathing slows, as you really indulge, if for only a few moments, how you’d be with all that extra cash on hand. It’s an amazing, albeit temporary salve, a balm to the anxious heart. And here’s the trick: We can recall that feeling over and over again and build on it, finding new ways to create the lives we want, just by using this tool of positive visualization. As our mind uses this, our thinking becomes stronger and we can begin to avert the waves of anxiety and in the spaces between, create constructive, positive events, in which to build the life of our dreams. Ironic that what starts with a fantasy – a one-dollar lotto ticket – can actually become reality, with positive visualization techniques tasked toward constructive events in real life context. And hey, we can use every tool we can find along the way, as I see it! Even for a buck!

Cheers and much love





Play pathways are also permanent and are present to some degree in everyone. Re-connecting with them, with or without your pain, is maybe the most powerful way out of pain. It is not even logical to think that if your pain was gone that you could enjoy your life. There are too many ways to experience pain. You have to first learn to enjoy life, understanding there are days you will enjoy it more than others. This is not about positive thinking, which is another way of suppressing negative thinking. It is about a positive outlook where you keep moving forward and staying engaged regardless of your circumstances.

 An old song returns

One example I often use in clinic is that any time you do not spend time practicing a skill, you will eventually lose it. My wife played guitar in her 20’s and became proficient in a picking style of performing. Two years ago she began to take lessons from an extraordinary Bay Area guitar teacher. About six months into her lessons, parts of some old songs began to return in her head. One day she sat down and played a complete piece that she had not thought about for decades. The pathways were still there. Anxiety and anger circuits will atrophy, if you turn your attention elsewhere. They will never completely disappear since these are also emotions that are necessary for survival and will be in play daily. By become aware of their influence, you will gradually spend less and less time on them.

Nurturing the part of your brain that enjoys life is a learned skill. That is why it is so critical what you choose to program it with. If your default state of mind is that of being agitated and upset, that is what will evolve. As you trigger the same response in those close to you, then there is no end to this universal ping pong game. Conversely, if you choose gratitude and joy, the same phenomenon will lift you upward. There is a lot to be angry about and also much to enjoy. What is your choice? How are you going to move forward? The Way to Love

Two Wolves


Listen to the Back in Control Radio podcast Moving Forward with Your Pain.


  1. Zarrabian MM, et al. “Relationship between sleep, pain, and disability in patients with spinal pathology.” Archives of Physical Medicine and Rehabilitation (2014); 95:1504-1509.
  2. Perkins FM and Henrik Kehlet. Chronic pain as an outcome of surgery. Anesthesiology (2000); 93: 1123-1133.