“Our envy of others devours us most of all”
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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

Positive Thinking vs. Real-time Reprogramming
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I’m a positive-minded person. I endeavor to never give up since I always think I will prevail over all adversity. Twenty-plus years of chronic LBP were not overcome by positive thinking. In fact, my almost exclusive reliance on my positive thinking added to my anxiety and fear of ever being … Read More

Using New Tools to Reclaim My Life
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    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

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

A Little Merrier Christmas – Letting Go of Blame
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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

From Would Like to Should – The Unenforceable Rules
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I was asking a friend of mine about what I could write about this week. He suggested, “What about resentment?” I hadn’t thought about this for a while but it’s a significant problem that does wear us down. Should There are many reasons for resentment. I think the essence of … Read More

Healing Begins at Home – DOC Starting Point
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This post reflects what I convey to my patients on the initial visit regardless whether the problem is amenable to surgery or not. It represents a specific starting point for the DOC process. Imagine I have finished my evaluation of your situation and we are discussing specific next steps. If … Read More

Escaping the Abyss – Which One??
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Spoiler alert – The Florida Project 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 … Read More

Life Sentence
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  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 – Optimizing Surgical Outcomes
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“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

How Not to Solve Chronic Pain
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The core pattern of human behavior to ensure survival has revolved around avoiding unpleasant body sensations, especially anxiety. The limited choices aren’t effective over time. We instinctively use two methods. Control Rigid structured thinking. Control takes the form of either escaping or controlling the situation creating distress and it works. … Read More

Romanticizing Pirates – Normalizing Suffering and Abuse
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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. This year we spent 5 … Read More

Wake the Fun up!!
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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

Happily Ever After
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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

Mirror Neurons and Your Family
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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

Chronic Pain is Solvable -Take Back Your Life
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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

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

The Taste of Freedom – Omega 2017
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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

Comprehending the Downside of Spine Surgery
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No one thinks that a surgical complication will happen to them. During my spine fellowship, I witnessed a large number of major complications and I was sure that I was going to be better than them – even though they were considered some of the top spine surgeons in the world. … 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 since humans cannot escape their thoughts, this process allows you to separate from them. The reason to destroy them is be … Read More

Descending into The Abyss – My Story
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My first migraine happened on the 4th of July. I was five and was excited because the local fireworks were being set off in the town commons directly across the street from our house. But as the sun set, my head began to throb and by 10 o’clock I had … Read More

It is Becoming Harder to Make a Living as a Surgeon………
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In late March this year I received this email from an educator in the South. I don’t recall how he found me. Dear Dr. Hanscom, Is there a doctor or clinic in the Nashville, TN area that you would recommend? I have ordered your book and look forward to the … 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

Your “Identity” Can Destroy You
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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

Omega 2017: Awareness, Hope, Forgiveness and Play
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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

Posterior Lumbar Fusion
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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

Never Give Up
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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

Eight-Level Spine Fusion? No!
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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

Trying Not to Be Judgmental
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Most people have heard of the psychological concept projection, a defense mechanism that allows us to transfer our unwanted feelings or behavior onto another person. For example, a person who is highly self-critical may constantly feel (or fear) criticism from others. When we judge people around us—either positively or negatively—we … 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

The Chronic Pain Marriage-Go-Round
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I have long asked the spouses 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), along with their partners. One reason is that partners of chronic pain patients also experience suffering—they have … Read More

Not Sharing Your Pain – Omega
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I have held three five-day workshops in NY at the Omega Institute in Rhinebeck, NY 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 on … 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

She Just Let Go
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My migraine headaches began on the Fourth of July when I was five years old. By age fifty I had over fifteen physical symptoms of an over-adrenalized nervous system. The last five years were extreme. After trying almost everything, I had completely lost hope of ever regaining any semblance of … Read More

Compassion
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A Course on Compassion: Empathy in the Face of Chronic Pain Click to view “A Course on Compassion” lecture videos 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 … Read More

The Two Faces of Christmas
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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

“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

The Placebo Effect – Harnessing the Body’s Healing Power
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The most powerful treatment for any disorder is stimulating your body to heal itself. I was introduced to this concept in the 1980’s by Dr. Bernie Siegel’s book, Love, Medicine and Miracles. He reviews some of literature that links stress with disease and also relates many stories of patients with … Read More

How Much Suffering Can You Take?
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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 Unconscious Brain
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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

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

Society’s Pain and World Peace
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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

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 deal with anxiety in a healthy way is critical to maintaining your quality of life. It is even more important for someone who experiences chronic pain. When you’re experiencing anxiety, your body chemistry changes. Chemicals are secreted that create 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

Moving Forward with Your Pain
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“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 … Read More

Be All that You Can Be – or Just Be
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The incidence of chronic disease is rampant amongst teenagers. A 2014 paper out of Indianapolis demonstrated an 830 percent increase in hospital admissions for pain in adolescents over a seven-year span. In the vast majority of patients a cause of the symptoms could not be found. I gave a talk … Read More

Out of the Valley, with Dolls
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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

Who Do You Choose to be Today?
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Last Tuesday morning, I woke up feeling low, having just completed eight straight 15-hour workdays. As I lay there exhausted, I reviewed my choices: either (1) stay in bed feeling sorry for myself; or (2) give thanks for the opportunity to help so many patients during the week, pat myself … Read More

Awareness, Hope, Forgiveness and Play
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These four elements form a powerful alliance to promote healing. The DOC program is simply one of the many applications of these age-old concepts. Awareness You cannot successfully address a problem unless you are aware of its root causes. But many people in pain stubbornly insist that, “The problem is … Read More

The Essence of the DOC Process
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“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

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

Take Back Your Life
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Stress is not the problem. It is your reaction to it that drains you of your life energy. Actually this statement is not completely correct. It is the stress. However, you also have a choice of whether to remain in the situation that is creating the stress. Let me explain. … Read More

Systematic Approach to Sleep
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Get some sleep – NOW Sleep is number one and I ask all my patients with insomnia to work with their primary care doctors to find a solution – and quickly. There are many ways to get a good night’s sleep and most physicians are comfortable with their own combination … Read More

Taking on the World’s Suffering
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The tipping point in successfully solving  chronic pain is becoming aware of your anger and processing it. When you are upset you body is full of stress hormone and as each organ system responds, you may experience many physical symptoms. When your anger drops these symptoms will diminish and usually … Read More

The “Benefits” of Becoming Disabled
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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

Rigid Thinking – “Make America Great Again”
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Rigid thinking, in addition to control, is another way humans deal with anxiety. Since I was raised in a chaotic household and had no idea how to stand up for myself, it was my default mechanism. I had strong opinions about everything and saw most issues in black and white … Read More

Societal Disintegration – Untreated Anxiety
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Human history is one of unending power struggles and violence. The patterns of behavior are established on the school ground and play out through adulthood. Every child has anxiety with it being more of a problem if he or she is from an abusive family. Aced Out They are thrown … 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

Stress and Getting Sick – Howard’s Golf Story
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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

Happy Father’s Day – Not
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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

Taking Charge of Your Care
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I want to share an email I received this week from a colleague regarding the effect of the DOC (Direct your Own Care) concepts in his practice. He is a retired orthopedic surgeon who is currently practicing addiction medicine. He and I have been in touch and I am helping … Read More

Lumbar Laminectomy/Laminotomy
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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

Lumbar Microdiscectomy
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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

“Better Not Look Down”
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A recent study demonstrated that thought suppression damages the hippocampus of your brain, which processes short and long-term memory. It is also been well-documented that when you try not to think of something, not only will you think about it more, there is a trampoline effect and you will think … Read More

The Pain of Social Isolation
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Many of my patients 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 … Read More

Surgery is the Definitive Solution?
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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

Perfectionism—The Ultimate Victim Role
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Perfectionism is an additional—and perhaps less examined— way that people play the victim. Many view perfection as the standard that must be reached in order to be successful. It’s held up as a virtue in all aspects of our lives, especially in professional and vocational endeavors. We feel pressure from … Read More

Out of the Abyss After 25 Years
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 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

Changing Your Story – Reframing
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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. Having a chronically negative … Read More

Remarkable Healing Stories – Dr. Bernie Siegel
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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

FAQ
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Forgiveness
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This is the part of the course that dramatically changed when I became more aware of the role of forgiveness in solving chronic pain. When the book, Forgive for Good became part of this process is when I began to witness patients consistently become pain free. Thoughts are always linked … Read More

The Science of Negative Writing
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I have discovered the easiest and most effective way of developing an awareness of my response to stress is to simply write down my disruptive, anxiety-producing thoughts and destroy them. It has been shown in over 200 research papers that this is an effective way of changing the body’s response … Read More

Negative Writing
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Writing separates you from your disturbing thoughts, so it can be used to help you let go. We are not our thoughts! When you create space between you and your thoughts, you can become connected to a bigger vision for your life—you are more than the pain you feel. Writing … Read More

Active Meditation
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We are a goal-oriented society that is focused outwardly on experiences and accomplishments.  We are spending little quiet time with ourselves and those close to us. Connecting to the current moment is the essence of fully experiencing your life. Active meditation is an effective and simple method to fully experience … Read More

Take Control of Your Own Healing
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You have learned the multiple variables that create and affect chronic pain. Regardless of the source of the pain your brain is being rapidly bombarded with unpleasant sensations that become magnified and memorized with time. Additionally they are linked with anxiety/ anger impulses that are also permanent pathways. This is … Read More

How Chronic Pain Evolves
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If you are one of the unfortunate people who experience pain longer than a couple of months, your brain has changed. In addition to your soft tissue injury or structural problem—your pain has evolved into a neurological problem. How did this happen? When the nervous system is barraged day after … Read More

There is Never One Answer
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There is never a single solution for your chronic pain. There are many factors that have to be addressed and each aspect has many individualized possibilities. It can be compared to fighting a forest fire. Clearly every possible resource is utilized to extinguish one. Local brigades can extinguish most wildfires … Read More

The Chronic Pain in Your Body is Generated in Your Brain
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I am a surgeon I have a problem being a surgeon and interacting with patients with chronic pain. I am trained to do surgery, so offering surgery is my first instinct. Referring physicians and my patients also often view surgery as the “definitive solution” to a given problem. When I … Read More

What is Myelin?
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All pain is “in your head.”  Every pain impulse has to be interpreted by your brain. Although your emotions do affect the perception of the pain, the pain is never imaginary and it is not “psychological.”  What happens with repetitive impulses is that your nervous system lays down pathways that … Read More

How the Brain can Change – Neuroplasticity
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Co-written with Gordon Irving, MD STOMP Dr. Gordon Irving is the medical director of the pain center at Swedish Hospital in Seattle, WA. He has developed a wonderful set of resources for dealing with chronic pain. His version of a structured program is STOMP (Structuring Your Own Management of Pain). … Read More

It’s Like Riding Your Bicycle
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Learning to Ride a Bike I don’t remember much about learning how to ride a bicycle.  I remember something about training wheels and taking a few nasty falls after they came off.  I do know that my father wasn’t there to help me or witness it.  He was a small … Read More

Pain Pathways are Permanent
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I have experienced many symptoms of Neurophysiological Disorder (NPD) that are essentially gone. However I am reminded intermittently that these circuits never disappear. When I quit practicing the tools that I regularly teach my patients several of my symptoms will reappear within two to three weeks. I will get lazy … Read More

Fighting a Forest Fire – Your Pain
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The negative impact of chronic pain on quality of life is more severe than heart failure, renal failure, or major depression and comparable to terminal cancer (2,3). Failing to adequately manage chronic pain has additional major consequences, which include: (1) Cardiovascular High blood pressure Heart attack Physiologic Loss of appetite … Read More

Mental or physical health – Which is more Critical?
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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

Aced Out
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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

“Stars Through the Bars”
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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

Your Personal Brain Scanner
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  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. … Read More

The Power of Pain
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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, “sociaization”. The First Day of School Every child … Read More

When will the Pain Stop?
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Mike is a local physical therapist who is a friend of mine. He has been interested the DOCC 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 the … Read More

Anger: Damage Control
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I have been through many phases of dealing with my own chronic pain issues. There was a time a few years ago where I labeled myself as “enlightened”, which meant in my mind that I was above going into the victim mode and could maintain a sense of tranquility. It … Read More

Solving the Unsolvable
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You have learned the multiple variables that create and affect chronic pain. Regardless of the source of the pain your brain is being rapidly bombarded with unpleasant sensations that become magnified and memorized with time. Additionally they are linked with anxiety/ anger impulses that are also permanent pathways. This is … Read More

Optimizing (Avoiding) Spine Surgery
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About three years ago my staff noticed that our surgical patients who participated in the DOCC project principles were doing much better. The successes were better and we were having fewer failures. The postoperative pain seemed less and more easily controlled. Patients were moving forward quickly with rehab while re-entering … Read More

Are You Kidding Me?
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Patients and physicians are not making logical or reasonable decisions regarding spine surgery. I have watched this phenomenon for almost 30 years and it is getting much worse. You have to be intelligent to make it through medical training. A basic concept in trying to repair anything in the mechanical … Read More

Rewire Your Brain – Omega 2015
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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

“The Unenforceable Rules”
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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

Your Unconscious Brain – Bull Riding
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Your unconscious brain processes data at an estimated one million times per second than your conscious brain and it evolved around avoiding anxiety. Every second of your body’s existence revolves around minimizing it regardless of what action is required. Lack of air, food, water, protection, and shelter all elicit a … 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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I’m continually searching for ways to understand and explain the Neurophysiological Disorder (NPD). Here’s one of my efforts. Every human being has anxiety as a necessary survival trait. Every cell in the human body has evolved to survive – not to have a great time. Unfortunately humans become anxious in … 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

The Enlightenment Light and Judgment Mirror
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55 years of pain I had a patient come into my office recently who represents one of the most remarkable turnarounds I have witnessed and she definitely has the record of being in pain for the longest time before she pulled out of it. She had been in pain for … Read More

Ready to Blossom – Omega 13
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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

Pain Rules the Roost
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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

“But You are Still Angry”
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Organizing your approach 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 using the … Read More

Destroyed by Bullies
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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

Your Book is Bullshit – The Encompassing Power of Anger
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An unhappy reader “Your book about back pain is bullshit! I learned the hard way that pain is an indication something is wrong. The unsuspecting public goes to idiot doctors like you that say, “It’s all in your head you crazy bitch.” Guess what, that pain I was told was … Read More

Trapped for 18 Years from Scoliosis Surgery
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Georgia 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 in a lot of pain. Normally pain from a fusion such as hers … Read More

Violence and Love
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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 … Read More

The Power of Love – Anthony
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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. Here … Read More

Structural Sciatica Resolved Without Surgery
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Background I received an anxious phone call from Jack, a 65 y/o retired businessman, asking me if I could see him urgently. His leg pain, which began 2months earlier, was quite severe. As his pain pattern was a classic pattern for the 5th lumbar nerve root (L5), and he was … Read More

“My Son Just Died”
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An identifiable source of pain George was a 78 year-old businessman who acted and looked about half his age. He was very 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 … Read More

Nick’s Winning Run – Off of the Hill
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Junior Nationals Champion 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 Junior Nationals in two years in a row in the Duals event. He was … Read More

Forgiveness as a Habit
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  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 … Read More

Happy Holidays – Not
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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

Know Your Surgeon – Before Surgery
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“Just get your surgery done” When the DOCC project began to evolve in 1999 it was my feeling that if there was a structural problem that it just needed to be dealt with surgically and then we could move ahead with the rest of the protocols. My reasoning was that … Read More

“I am Paying You to Inflict Pain??”
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Scott This is Scott. Every Tuesday and Thursday at 6 am I work out with three other guys. Scott is our personal trainer and this is his picture at the gym on Halloween. He is a little unusual in that he laughs at us – the whole time we are … Read More

The Gift of Pain – Thanksgiving 2013
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Paul Brand 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 … Read More

Am I Operating on Your Pain or Anxiety?
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My surgical decision-making has become a clearer over this last couple of weeks – but in an unexpected way. I have noticed this year that many patients with significant structural anatomic problems will improve or resolve their symptoms without surgery after engaging in a self-directed structured approach. It appears that … Read More

Never Give Up – Breaking Through After Six Years
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You cannot fix yourself You cannot fix pain pathways. You can only implement strategies that cause your nervous system to heal and become an observer of your own healing. The harder you try to “fix” pain pathways the stronger they will become. Bent forward Terry is a middle-aged mother of … Read More

Breaking Loose – Not Quite
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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

Escaping Your Family – The Crab Bucket
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It is documented in the medical literature that having a family member on disability was a significant risk factor for becoming disabled. I did not initially understand this connection but now know it is powerful. It centers around how you learn your family patterns. The initial download to your brain … Read More

“The Cup Song”
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Could it be that the answer to chronic mental or physical pain is The Cup Song? Omega Institute, August, 2013 Dr. Fred Luskin, author of Forgive for Good, my wife, Babs, and I put on a five-day workshop at the Omega Institute in Rhinebeck, NY. The course was intended to … Read More

I Almost Died on Monday
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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 even … Read More

To Become Strong – “ILOHLA”
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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

Jennifer’s Permanent Pain Pathways
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I did surgery on Jennifer 18 years ago for a missed spine infection. Here is the link to her story. We Are Not Broken I thought I had definitively solved her problem. With her fusion solid and her infection cleared she structurally was cured. She went on to develop severe chronic … Read More

“I Read Your Book and I Still Hurt”
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Johanna Johanna was a 40 y/o woman I saw a few years ago who had been experiencing LBP for about 12 years. She had degenerated discs down the length of her spine. Her pain was constant and severe. She had been disabled since her pain began at work while lifting. … Read More

Ugolino
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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

My Migraines
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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

Dr. David Hanscom Interviewed on WFXT-TV Fox Boston
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An interview with Dr. David Hanscom, author of Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain, on WFXT-TV in Boston on May 9, 2013. His book …

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 external stimuli and direct various organ systems to respond in specific ways to maximize your ability to survive and thrive. While … Read More

Mastering Pain Pathways – Shuhari
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Pain pathways are permanent The foundation of the DOCC project is understanding that pain pathways are laid down in your brain quickly and they are permanent. It is unclear in a given person when acute pain becomes chronic. Once that line is crossed the “pain switch” in your nervous system … Read More

Bullying – My Challenge to the Charter for Compassion
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I am a partner in the Charter for Compassion. They are doing some wonderful things regarding creating an awareness of the need for compassion as well as supporting some great projects. However I think all of us need to dig much deeper. Sartatoga Teen Hangs Herself I am upset. It … 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 most deadly emotion we suppress is anxiety. It is a survival response and our whole being is repulsed by … Read More

Compassion in Medicine
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Charter for Compassion I am an active member in the Charter for Compassion. There is a sub-group forming looking at compassion in medicine. I realized a while ago that my relationship with my patients was an important part of the healing process. What I did not realize for a long … 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 interviewed on a radio program and somehow the topic of tinnitus came up. The host shared … Read More

“Self-Esteem” Must Die
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In our society today, it’s commonly believed that the higher you think 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 concept that … Read More

STOMP – Structuring Your Own Management of Pain
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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

Avoid Surgery by Raising the Pain Threshold
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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

Play
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Happiness is Learned Happiness is a learned skill. I am learning as my patients have taught me about healing that there is possibly a faster way a reach a pain free state. Anger and pain pathways are tightly joined. It is not possible to achieve success unless you have truly … Read More

The Angry Meditator
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Meditation should be taught in elementary school Meditation is a skill that every human being 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 over his … Read More

You Cannot Fix Yourself
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You can only implement strategies that allow your brain to heal. Let me explain. A Good Student I am learning that being a “good student” of the DOCC project is not always the best course of action. I used to be very encouraged when a given patient would avidly read … Read More

Can Your Body Language Change Chronic Pain?
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Dr. Gordon Irving is the head of the Swedish Medical Center Chronic Pain Program. His group has embraced the treatment principles of the Mind Body Syndrome. All of us have different tools and styles but the essence of our approaches is similar. You cannot calm your mind with your mind … Read More

“The Doctor is Missing Something”
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Neurological Pathways The Neurophysiological Disorder (NPD) describes the body’s memorized response to stress and also what occurs when your body has high levels of adrenaline. There are many symptoms that disappear with the successful treatment of NPD. Most of them are physical. The most difficult concept for many patients to grasp … Read More

Anger versus Angel
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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.

“Love Actually”
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Connection I watched a movie this week, “Love Actually.” It was a collection of about eight relationship stories occurring around the Christmas season. There were some wonderful endings and few dismal failures. However, regardless of the status of the romance it highlighted the importance of human connection. Regardless of what … Read More

Physical versus Emotional Pain
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The Swerve I recently read a book, “The Swerve” by Steven Greenblatt. It is a historical account of a papal scribe’s discovery in 1417 of a poem, “The Nature of Things”. Lucretius wrote it almost 1000 years earlier. He makes a case that it was the discovery of this poem … Read More

Sarah’s “Ceiling Walk”
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Lenny is a good friend of mine who teaches many aspects of theater. His expertise includes mask dancing and mime. He is extraordinarily aware of body movement. I was talking to him one day about the mind body connection and he related the following story to me. Lenny’s Class Sarah … Read More

“I am Becoming the Person I Never Wanted to Be”
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Golden Years?? I met a wonderful woman a few weeks ago who was suffering from severe spine problems. She was a successful small business owner who had been able to retire a few years ago in her early 60’s. She had family support and spent time helping out small non-profit … Read More

Re-uniting With His Wife
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A three-level fusion?? Bill is a middle-aged executive who has experienced many Mind Body symptoms. He had a structural low back problem that required a multiple-level decompression. He initially was not open to any of the ideas of the DOCC project until about a year later when all of his … Read More

Healing Power Within—Warts
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Warts My junior year in high school I developed warts on my hands. They were not subtle and they did not go away. There was always three or four of them at any given point in time. Being 17 years old with these things all over both of my hands … Read More

Gratitude
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Today I am able to take a few minutes to reflect on the many aspects of my life that I am thankful for. I have spent most of my life in the opposite way of thinking. No matter how many parts of my life were good I was always stuck … Read More

Leg Pain Gone with MBS Principles-Maggie’s Story
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Maggie 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 from the middle of Washington State and a … 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 … Read More

“Finding Health by Letting Go of Hate”
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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

Elevator Pitch for “Back in Control”
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“On Fire” I came out of my spine surgical training with zeal in 1986. Surgery was the definitive solution. By definition if a patient reached my office I felt compelled to do something and felt badly if I could not. I had no idea that the nervous system had so … Read More

The Elephant’s Noose
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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

Action Not Apologies
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Pain = Anger = Abuse There is a strong link between pain, anger, and abuse.  With few exceptions abusive people do not want to be that way. The problem is the lack of self-awareness that you are being abusive. When you are upset you are detached from the details of … Read More

Mold Your Brain: Neuroplasticity
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Co-written with Gordon Irving, MD STOMP Dr. Gordon Irving is the medical director of the pain center at Swedish Hospital in Seattle, WA. He has developed a wonderful set of resources for dealing with chronic pain. His version of a structured program is STOMP (Structuring Your Own Management of Pain). … Read More

Mirror Neurons—Family Healing
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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

Unhooking from the Train
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Neurophysiological Disorder? 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 reason why it is such an effective … Read More

My Feet on Fire
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My Orthopedic Training 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 … Read More

School or Prison-What’s the Difference? Bullying
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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

Charley’s Story: Pain Free After 17 Doctors
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This is a story of a man who became pain free using DOC Project principles. He had seen 17 doctors before engaging in these concepts. His letter I met Dr. Hanscom under the most stressful circumstances imaginable. When I moved back to the Northwest a little over a year ago, … Read More

“Just Fix Me”
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A Young Couple I had a young couple come into clinic last week. The husband worked as a machinist. He was good at his job and in high demand. The wife stayed at home to care for their two young children. The husband had been experiencing back pain after hearing … Read More

My Midnight Trip to the Dentist
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My Dentist My dentist is a great guy. Our children played sports together. Still, I really hate 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 skipped a few visits. It turned out … 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 there is a much higher chance physical symptoms will be caused by changes in the body’s chemistry and each organ … Read More

Protect Your Family from Your Pain
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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

“Many Italians Choose Suicide” – People Need to Work
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Doctors Are Not Trained in Workforce Issues 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 … Read More

Your Hand Stuck Over the Stove
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Picture taken from Ernesto Sanchez’s guest post, “The Journey of 1000 Moons” “I’m Fine” Here’s a puzzling situation I often encounter: 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. … Read More

Anger and Workers’ Comp
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A Failed System 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 … 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

Anger Simplified
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Anger = loss of control The need for control is caused by anxiety Therefore Anger = anxiety + adrenaline BF

Taking Back Your Spirit-Caroline Myss
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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 Am Not Letting Yesterday Ruin Today”
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Another Ruptered Disc I have known Anne for a couple of years. She had been experiencing chronic pain for a couple of 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

Labeled “Drug Seeker” and Almost Died
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Mary’s Letter Hi Dr. Hanscom, I know that you had asked me to send you an email telling you how it made me feel when L&I “stereotyped/categorized/labeled” me. The First Surgery I know that you had asked for another story but I felt compelled to tell you about the first … Read More

Discovering I had Neurophysiologic Disorder (NPD)
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I personally experienced the full spectrum of the Neurophysiological Disorder (NPD) from 1990 to 2004. I had no idea what was happening and learned an effective treatment strategy by taking every possible wrong turn. I have experienced over half of the 33 NPD symptoms that Dr. Schubiner describes in chapter 5 … Read More

Hod Carriers and a Frayed Wire
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I have a good friend, Dennis, who related an interesting experience he had regarding Sensitization to Pain. The Job It occurred when he was working as a hod carrier in his early twenties. A hod carrier is a person who sets up the work area for brick masons. Essentially, the hod carrier … 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. Schubiner 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 … Read More

Not Being Judgmental
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Controlling your thoughts It is impossible to control your thoughts indefinitely. The more energy you put into trying the more you will eventually suffer – either from mental or physical symptoms. It has been well-documented that more you try not to think about something the more you will think about … Read More

The KKK and a Spiritual Journey
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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

Staying in the Storm
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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, family … Read More

A – Structural Sources of Pain
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Dogma It is an almost universally held belief among surgeons and patients that a specific structural lesion is usually the source 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 … Read More

You are Not a Machine
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Identifiable Sources of Pain Pain is a perception that can be affected by several categories of variables. 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 … Read More

Unlearning How to Ride Your Bicycle
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Learning to Ride a Bike I don’t remember much about learning how to ride a bicycle.  I remember something about training wheels and taking a few nasty falls after they came off. I do know that my father wasn’t there to help me or witness it. He was a small … Read More

Patient’s Feedback on “The Snarled Stumper”
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Backstory I wrote a letter to the “Roundtable” in reponse to a story about a patient who had undergone a straighfowrd simple knee surgery with a terrible result. (I’ve talked about this patient before in “The Snarled Stumper.”)He was in terrible pain, worse than before surgery. This is Anne’s input … Read More

Ron Salvages His Own Spine Surgery
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A Letter 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 he did not improve.  … Read More

“The Snarled Stumper” – Noncompliant Patients
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The Case The “snarled stumper” is a case of a logger who incurred a relatively mild knee injury at work. He underwent a simple arthroscopy. After the operation, he experienced much more severe pain than before. Every intervention since that point has been ineffective.  Within eight months, his quality of … Read More

Dr. Schubiner-Can Tics Be Contagious?
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The tools that are presented on this website treat the Mind Body Syndrome of which chronic pain is a common manifestation. I was not aware of the Mind Body Syndrome until Dr. Schubiner taught me about it last year. Whether you use my approach or Dr. Schubiner’s or both, it … Read More

Pain to Pleasure-Pavlov’s Dogs
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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

A New Life at 72
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Crystal is a woman from the southern part of Washington. She is 72 years old and lives on her own. Her family lives in California. When I met her, she had severe spinal stenosis in her lumbar spine at multiple levels. This is a condition where bone and ligaments grow … Read More

Anger-The Absolute Block
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You Will Get Better 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 … Read More

“Buying” Anxiety
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Anxiety Off of Work Essentially every patient I see that has been off work more than three months has elevated anxiety. This gets noted on my intake questionnaire or comes out in conversation. I always directly address the anxiety. If I had a choice, every patient would have some access … Read More

Everyone Needs Support
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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

Maslow’s Miss
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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 usually … Read More

Video 18/19: The Myth of Self Esteem & Anxiety
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I talk about the myth of self-esteem and the negative connotations that this concept can have on us. For more, see The Myth of Self Esteem. BF

You Are Not Your Thoughts
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You Are Not Your Thoughts “You are not your thoughts.” Philosophers have been telling us this for centuries. In our modern era, this idea has often been overlooked. The problem is that thoughts are real as well as your body’s chemical response to them. Nice thoughts stimulate the secretion of … Read More

Video 17/19: 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

Doctors Treat Themselves Differently
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Is the Best Treatment No Treatment? The roundtable sent out a reference to an article about how doctors treat themselves when they are faced with end-of-life decisions. Often, what a doctor chooses for himself is not what he would choose for a patient. The majority choose to forego intensive treatments … Read More

Breaking Loose – NOT
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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

The “Five E’s” of Chronic Pain
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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

Reactive to Creative
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Both hard work and creativity are important in being successful in developing and implementing new ideas, both personally and in the business world. It can be argued that insanity is the antithesis of creativity. Consider Albert Einstein’s thoughts on what constitutes insane behavior? Insanity is Doing the same thing Over … Read More

“C”ing Clearly
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CREATIVE REACTIVE The difference is the location of “C”.

Visualization – Holt’s Winning Run
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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

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

My Call to Action
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Jean was a middle-aged rancher who I saw for a second opinion from a neighboring state. She filled out an extensive spine pain questionnaire, which included many psychosocial questions in addition to a history and diagram of the pain. She was healthy and normally an extremely physically active rancher. Her low back … Read More

Your Spiritual Journey
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There are recent studies showing that, by using relatively little distraction, the perception of pain can be diminished.  I think there are many ways of distracting the nervous system so pain is not at the forefront.  However, pain is relentless and it is not possible to sustain this re-direction of … Read More

The Power of Commitment
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The key to reprogramming your nervous system and stimulating neuroplastic changes is repetition. There has been much research done on why it is so difficult to change behavior. We all know how difficult it is to keep New Year’s resolutions. Why is that? We are often quite serious about it … Read More

Think Twice About Spinal Surgery
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Advertisement by Roy Carey, a well respected spinal surgeon in Melbourne. This advertisement helped reduce the frequency of spinal surgery in Victoria, New Zealand. BF

Video 15/19: Anger Fueled Anxiety-“The Highway to Hell”
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I discuss how anger is the turbocharger that keeps anxiety both covered up and fired up. Until you turn off anger you will not get a handle on your anxiety or your pain. It’s something I talk about more in Anger and Anxiety-“The Highway to Hell”.   BF

Template for Your Personal “Business Plan”
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About once every one to two years, I go through a process that helps me organize my thinking about my own life.  It is the norm for most of us to run our lives by continually fixing problems.  We not only get worn down, but we don’t have the pleasure … Read More

Communicate with Injured Workers
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This letter is in response to a process that was outlined by one of the roundtable participants.  She has every party involved in mangaging a given claim.  They meet every 45 days and outline a clear plan.  It is a remarkably forward-thinking concept and very effective. Hi _____, I think … Read More

Video 14/19: Chronic Pain: Pain Free is Not Only Possible, it’s Probable.
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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

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 13 / 19: 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. BF

Compassion and an Italian Dinner
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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

Video 12/19: 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

How Many More Neck Surgeries?
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One patient of mind sought me out from Florida for a second opinion on his neck.  He was about 50 years old and had been disabled since 2001 with chronic pain over most of his body.  He had at least 10 different symptoms of burning, aching, stabbing, and tingling that would … Read More

Video 11/19: I Can Only Fix What I Can See
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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. My Original Surgical Philosophy prescribed to this belief. I thought that surgery could … Read More

Enjoy Your Day-Today
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“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 appearance, … Read More

The First and Last Day of School
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“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

Degenerated Discs are NOT a Disease
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I consider the difference between a structural and muscular problem in relation to degenerated discs disease and back pain. I talk about this at length in Degenerated Discs Don’t Cause LBP. BF

“I Am Not Angry”
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A few years ago, I evaluated a retired businessman for pain down the front of his right leg. It had begun about eight months earlier. The pain was moderate but frustrating. He had not experienced prior back problems and was not used to dealing with pain.  It was unclear what … Read More

Video 9/19: 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 “Defining the Source of the Pain.” BF

Pain = Anger = Abuse
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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

Video 8/19: Fusions For LBP Don’t Work
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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

Problems are Opportunities
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I was in clinic today and a new patient cancelled.  I had the chance to spend some extra time with Lisa, a patient that I am just beginning to get to know. We had a long discussion about the DOCC Project.  Although she was initially resistant to the DOCC Project, … Read More

Video 7/19: The Catastrophe Index
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I specialize in Spinal Deformity and salvage operations. In this video, I talk about the cost of unnecessary surgeries and the emotional toll that is can have on patients. It’s something I’ve written about in The “Catastrophe Index.” BF

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 6/19: Standard Stress Skills Inadequate
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I talk about how the DOCC Project can relate to other aspects of our everyday life, including everyday stressors and suppression. This is related to some of what I talk about in “Memorization of Neurological Circuits.” BF

Video 5/19: Surgeons Do What They are Trained to Do
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I talk about the lack of awareness to the alternative approaches in the spine surgeon world and the treatment of chronic pain. Sometimes I wonder, “What Are We Doing?”

Examiners from the Worker’s Perspective
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From my perspective, life in the worker’s comp system for my patients has never been more difficult.  The improvement in overall numbers belies the daily struggles of my patients who are admittedly an unusual group.  Many of them have been referred to me after “failed surgery” or have been in … Read More

Video 4/19: Listen When Your Surgeon Says “No”
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I discuss how the DOCC Project model organizes all of the concepts of one’s pain into an understandable format and identifies certain tools that are variably to help one take back control of their life and overcome chronic pain. BF

Video 3/19: Completely Trapped
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I talk about the frustration and the feeling of being trapped by chronic pain and how using the DOCC Project will help get your pain “Back in Control”. Remember: Anger = Loss of Control. BF

Arm the Worker
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Fixing the problems with the worker’s comp system is critical.  However, the system is unwieldy and we are not going to change it anytime soon.  We know extremely well what needs to happen to enable a worker to move smoothly through the system.  One of my physiatrist colleagues felt so … Read More

Response to “Treat the Abyss” From the Roundtable
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In response to some things said at the roundtable, I want say a few things about the emotional aspects of chronic pain treatment–namely, the additional stress caused by worker’s comp, the underlying anger of chronic pain, and the stigma of psychological diagnosis. Most people have a lot on their plate … Read More

THE “ROUNDTABLE”
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An physician friend of mine founded an international internet forum for professionals who are deeply involved in caring for injured workers.  Over the last several years, it has grown to over 1200 members who are committed to creating and implementing solutions to the multitude of problems that exist within the … Read More

Video 2/19: Your Hand Over the Stove
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Consider a situation where you are forced to hold your hand next to the hot burner of a stove.  What would happen to your anxiety?  What would be your next response?  In chronic pain, you “can’t get your hand away from the stove.” I talk about this in depth in … Read More

Treat the “Abyss”
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There is an ongoing debate amongst physicians whether anxiety and anger should be addressed in the treatment of chronic pain.  It is the “common wisdom” in medicine that the reason patients on worker’s comp do not do well with medical interventions, especially surgery, is that they have too many “secondary … Read More

Video 1/19: Introducing 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. For the basics of … Read More

The Eye of the Storm
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Any time your sense of well-being or peace of mind is dependent on external factors, you are at the mercy of those circumstances. For instance, if you feel the need for approval from your boss or peers, then you have given them a lot of power if they withhold their … Read More

“I Understand Your Anger. Get Over It.”
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I was relaxing this weekend and cleaning up stacks of papers that have been piling up over the last six months.  I ran across this letter a patient had shared with me from her prior surgeon. She had undergone a major low back surgery and came to me with unrelenting … Read More

Video 8 of 19: Finding the Source of The Pain
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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. BF

Video 5 of 19: An Alternative Approach to Chronic Pain & Spine Surgery
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I talk about the lack of awareness to the alternative approaches in the spine surgeon world and the treatment of chronic pain. BF

It Really is Upside Down
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I have a patient who is a muscular 43 y/o welder. He injured his back on the job about four years ago.  After undergoing a laminectomy for low back pain, his pain actually increased.  When I first saw him a couple of years ago, his complaint was unrelenting low back … Read More

Depression Masking as Pain
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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

“Call Things by Their Right Names”
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The culture of medicine is immersed in high standards, ideals, and perfections.  Society demands perfection from physicians.  It is manifested in many ways.  The legal system, hospital staff privileging, no mercy for personal mental health issues, harsh criticism from our mentors.  Consequently, as others judge us, we are idealistic regarding … Read More

Awareness
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Why is awareness being brought up in the middle of a project about dealing with chronic pain?  Remember there are three steps to the reprogramming your nervous system. Awareness Detachment Reprogramming There are many concepts of awareness. The definition of awareness that resonates with me is: “Being fully present in … Read More

Introduction to the DOCC Project for Pain Management – “Back In Control”
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“Back In Control” is my book about the DOCC Project. This video is an introduction to the DOCC Project, which is a pain management program to get your pain back In control. BF

“The Journey of 1000 Moons”
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“The Journey of 1000 Moons” If you count the moon cycles you will experience in your lifetime, by the time you reach 77 years of age, you will have experienced one thousand. As we live these years, how often do we stop and think about the presence of the moon … Read More

David Burn’s Letter
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Self-directed Cognitive Behavioral Therapy 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.  Inadvertently, I discovered that patients would notice significant improvement within a few weeks.  Historically, I could not get … Read More

Out of the Abyss with Forgiveness
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Hi Dr. Hanscom, It’s Beverly, 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 classes … Read More

“The Pit of Despair”
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Harry Harlow was an internationally renowned psychologist who pioneered research in human maternal-infant bonding using primates.  During the first half of the 20th century, it was felt that mothers should touch their children as little as possible.  The leading mental health professionals aggressively discouraged mother-child interaction in research papers, lectures, … 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

A Tale of Two Golf Holes
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I love golf. I love the social aspect of it. I love to hit a great golf shot. There is nothing quite like hitting the “sweet spot” and feeling the ball take off like a rocket. The problem is that I don’t get to experience that sensation very often. I … Read More

Psychoses-“Phantom Brain Pain”
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Chronic pain involves a web of variables that can be complex, but often patients don’t want a complicated explanation for their pain. The pain is so severe, and so difficult to live with, that they just want to hear a simple root cause. They are often stuck on the idea … Read More

Bipolar Disorder Broken
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Debbie is a 45 y/o woman who I have been working with for about four years. She was diagnosed with a severe bipolar disorder at age twelve. About 10 years ago, she had a lifting injury at work and developed chronic low back pain. Over a series of eight years, … 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 300 research papers that document that expressive writing 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 general feeling of … Read More

Your Demons are Robots
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It is critical to understand how deeply your negative anxiety-producing thoughts become etched into your nervous system.  The White Bear experiment I referred to in another post is the crux of the whole mental health model around anxiety.   The 1987 Harvard experiment documented that when you suppress thoughts, they become … Read More

Reprogramming the Nervous System
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Notice how much of your life is affected by negative spinning thoughts in response to the stresses of daily life. If there is a genuine crisis, these spinning thoughts can become intense. Chronic pain is a major stress. Over time these negative circuits strengthen. Talking about your problems just reinforces and … Read More

Normal Arms Amputated
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It is extremely critical for you to understand how powerfully your neurological system can embed pathways into the nervous system.  In a sense, your nervous system can learn specific pathways. The nervous system does this in the same way one learns anything—by repetition. Repetition is how chronic pain develops. With … Read More

“I Want to Believe”
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Florence, Italy My wife lived in Florence, Italy from 1983 to 1990.  She is fluent in Italian and some of her best friends live in Italy.  We go back every year to spend time with our friends and enjoy the Italian culture.  In 2009, I took three weeks off to … Read More

The Catastrophe Index
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The danger of falling into the “abyss” is that it makes chronic pain patients more vulnerable to the suggestion of surgery, which is often unnecessary.  Along with the possibility of surgery comes the risk of catastrophe. Here are a few examples. The cases of these patients are not unusual. A … Read More

Your Doctor Might Not be Listening
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Doctors are trained to “fix” Chronic pain patients often feel a lack of compassion from the health care community. Physicians, as a group, tend not to take time to listen to patients. Our training emphasizes taking action – in the form of prescribing treatments – instead of listening. Medical school … Read More

“The Abyss”
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Some say that chronic pain is “in your head” or “psychological” pain. Your pain is not imaginary pain. Your nervous system is ablaze, which alters the body’s chemistry. Animal research has shown that when your body is full of adrenaline that the speed of nerves conduction increases and you will … Read More

The Surgical “Grid”
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These are four groups of patients: IA—Structural lesion, low risk for chronic pain IB—Structural lesion, at risk for chronic pain (high stress) IIA—Non-structural lesion, low risk for chronic pain IIB—Non-structural lesion, at risk for chronic pain (high stress) An overview of how this looks is presented in this grid: Low … Read More

Surgically Profiling Yourself
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Spine surgery has a poor reputation. Many people know patients who have undergone multiple surgeries and have ended up crippled. However, spine surgery can also be seemingly miraculous in giving a patient her life back. There are some principles you should be aware of that have a major influence on … Read More

Defining Non-operative Care
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Based on the principles I have learned through the DOCC Project, I would propose the following definition of “failure of conservative care.” “Failure of conservative care” is defined as ongoing pain after successfully treating the central nervous system and the soft tissue components of a medical case. In the case … Read More

Surgical Results Overly Optimistic
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What percentage of success would you want from your potential surgery on your lower back before you decided to proceed with a major surgical intervention such as a back fusion or artificial disc? Most of my patients feel that they would like a greater than 75% chance of significantly decreasing … Read More

What Are We Doing?
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I am tired of the carnage. Every week I see one to six patients who have undergone botched spinal surgeries that never had a good chance of success. Not only is the goal of surgery unattained, but the surgical trauma to the spine is often very severe. I would estimate … Read More

Failure of Conservative Care
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I went to a national spine meeting in Philadelphia in the fall of 2005.  I was with one of my partners who is also a spine surgeon.  We had just heard two papers presented regarding the results of lumbar fusions in patients who were injured on the job and were … Read More

Indications for Surgery
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In order for a surgery to go right the first time, you need an idea of when spine surgery is appropriate and at what level of complexity.  There is not an operation that is effective for non-specific low back pain. For the most part then, spine surgery for lower back pain … Read More

Worsening Prognosis with Time Off of Work
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It is well documented in several studies that the chance of ever returning to work dramatically decreases the longer a person is off from work.  Dr. Gordon Waddell showed in the 1980’s that if a worker is off from work for a year, the chance of ever returning to work is … Read More

Degenerated Discs are Normal as We Age
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It has been known and documented for decades that discs lose water content and become less flexible as you age.  I will never forget a Golf Digest article many years ago showing Jack Nicklaus’s golf swing his first years on the tour compared to 20 years later.  In his early … Read More

What Do We Know?
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There are many things that we do not know about low back pain or chronic pain.  Yet there are many facts that are clear.  Here is a list of what we know: Exact diagnosis of LBP is usually unclear Discs normally degenerate with age Little association as a cause of … Read More

Source of LBP is Unclear
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Generally, when low back pain is associated with minim