Darkness – “The Abyss”
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When you’re suffering from chronic pain, your nervous system is ablaze. The medical term for this is “central sensitization syndrome” (CSS). Indeed, animal research has shown that when your body is full of adrenaline and other stress chemicals that the speed of nerve conduction increases (almost doubles), so you’ll experience … Read More

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

Healing Begins at Home – 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

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

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

Verbal “Expressive Writing”
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Freely writing your thoughts and immediately destroying them has been the starting point for almost every person I have seen heal. My concept of why it is effective is 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

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

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

OCD is No Fun and Not Funny – Extreme Mental Pain
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Neil Hilborn – “OCD” Obsessive Compulsive Disorder (OCD) is an extreme of form of anxiety. It is characterized by a relentless assault of unwelcome intrusive thoughts. I suffered from OCD for several decades well before I knew what OCD meant. The beginning My anxiety became disruptive one night in 1990 … Read More

Not Sharing Your Pain – Omega
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I have held 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

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

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

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

Anxiety
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  The ability to 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

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

Systematic Approach to Sleep
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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

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

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

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

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

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

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

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

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

Physical versus Emotional Pain
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The Swerve 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

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

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

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

Charley’s Story: Pain Free After 17 Doctors
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This is a story of a 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

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

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

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

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

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

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

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

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

“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

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

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

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

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

Write and Don’t Stop!
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  There are over 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

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

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

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

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

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

B – Non-Structural Pain
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It can be difficult for patients to accept that their problem is, essentially, “undetectable.” They are in so much pain, it seems impossible that so many tests would come up negative. In truth, physicians can make an exact diagnosis of the source of low back pain only about fifteen percent of … Read More

The Myth of Self-Esteem
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Self-esteem is one of the worst concepts ever propagated. The notion implies that if I had enough of “X,” then I would have less anxiety, less frustration, and more happiness. “X” can be a material thing, an experience, a relationship–almost anything. Self-esteem must die Self-esteem is a subtle attempt at … Read More

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

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. As … Read More

Sleep
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Incorporating sleep into my treatment of pain was my first step in starting the DOC Project. I felt I had a whole new weapon that was very effective and simple. I realized that once I was successful in getting my patients to sleep, there was always some improvement in their … Read More

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

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

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

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

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

2 – Sensitization to Pain
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See me talk about this in a video:  Your Brain Becomes Sensitized. I frequently encounter patients who feel that there must be an anatomical problem that is progressing as their pain is getting worse.  There has been no further injury.  Nonetheless, these patients become even more focused on finding the problem … Read More

Four Steps in the Evolution of Chronic Pain
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There are four primary steps in the evolution of chronic pain: (1) There is a source for the pain, which may or may not be readily identifiable Structural–identifiable lesion with MATCHING symptoms Non-structural–inflammation or irritation of the soft tissues, which cannot be seen on a test Mind Body Syndrome–the nervous … Read More

1 – Three Sources of Chronic Pain
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Dr. Howard Schubiner Dr. Schubiner is a pain physician practicing in Detroit, MI. He approaches pain from a Mind Body Syndrome model, which will be explained later in detail. I asked him to explain how he conceptualizes the source of pain. The next few paragraphs are his concepts. Three Sources … Read More