It’s pretty discouraging. I mean, I love my practice. I love being a surgeon. I love my team. We have well over 1000 patients who simply went to pain-free using the strategies outlined in back control.

So let me pretend you, let me pretend you’re my patient for a second. So you’ve had back pain for two years. And you come to me, I say “Look, here’s my book. Here’s the website.” I don’t try to tell you too much in the first visit, because it’s pretty overwhelming.

Because first of all, you’re thinking that the pain is coming from your back, right? There’s signals coming from, your back, that are going to your brain that says this, this back is painful. Remember, the back pain has been there for two years. The pain’s shifted from the pain centre to your emotional centre. It’s not even in the pain centre of your brain.

So the pain signal’s actually coming from the emotional centre, even though you’re still feeling back pain. It’s a different animal completely. So on stage one of the website which is backincontrol.com, here we do what’s called expressive writing. You simply write down your thoughts and tear ‘em up.

As we pointed out before, you can’t escape your thoughts, but you can separate from them. Well, we think of expressive writing, it’s the only one mandatory step of the entire process, which is not the solution, but it’s a starting point.

There’s over 1000 research papers that documents that different forms of expressive writing make a difference. The research was started by Dr. James Pennebaker in 1982. He just published a book called ”Open up by Writing It Down” by Dr. Pennebaker, Dr. Smyth, and he points out the effectiveness of expressing writing is unbelievable.

PTSD, asthma, rheumatoid arthritis, improved skin healing. I mean, it’s unbelievable what this thing does to the physical part of the body. And we don’t know exactly the best form of expression for it for a given person. But basically it’s write down your thoughts, tear ‘em up.

And you tear ‘em up for two reasons. One of them is to write with freedom, positive or negative. Most of the research, by the way, has been done on negative writing. But the bigger reason to tear them up is to not analyse it, because they’re just thoughts.

You don’t want to analyse them and fix them. The whole concept’ based on what’s called neuro-plasticity. Your brain changes every second, your brain’s going to develop exactly where it places attention. So you’re going to analyse all these thoughts, you’re actually going to reinforce them. Right?

So that’s the starting point is expressive writing, step three, which is all based on neural plasticity, which is awareness, separation reprogramming, called active meditation. So just drop your shoulders for a second. Take a deep breath. Okay, how that feel?

Feels pretty good.

Yeah, so it’s just, you know, three to five seconds, we actually do it during surgery, by the way, what you’re doing, you’re changing sensory input from racing thoughts, to a different sensation. That’s it.

Okay.

And I do try to twenty-30 times a day, I wish I could do it more. I will say it’s become somewhat automatic. But yeah, just changing sensory input simply changes the body’s chemical response, you drop your muscles that relaxes the body chemistry a bit.

Yeah.

But also changing the sensation from these unpleasant racing thoughts to a different sensation is very powerful. Taste your food, feel the breeze, etc.

Yeah

Just about 3-5 seconds multiple times per day. It’s what I call active meditation.

The fourth step is sleep, which we just discussed, sleep is a huge deal. I make the point that none of this works without sleep.
And then the final step in stage one is, if you’re in my office, I say “look, I know you have back pain. And you’re probably talking to your friends and family about this somewhat endlessly.”

And it took me a long time to figure out that people in chronic pain, talk about the pain all the time. But I realized from my own experience of 15 years with chronic pain. I talked about my pain all the time because it consumed my life. And you’re looking for a cure.

Yeah

The problem is, where’s your attention?

Yeah

Your attention is on the pain.

Yeah.

So from a neuroplasticity, so we think neuroplasticity, not psychology. If you’re talking about your pain, that’s going to send you right into a hornet’s nest. Because you’re not going to fix the problem, because you’re going to reinforce it.

Yeah.

One of the one of the metaphors I use for solving chronic pain from a neuroplasticity standpoint, you’re going to learn a new language, you’re going to practice you’re gonna learn French, you’re going to take the classes, you’ll practice. You might immerse yourself in the country of France. Let’s say if ….now you can speak French. Something happened to your brain.

Yeah.

David Hanscom Connection’s and wiring. So something changed in your brain. It’s not motor memory it’s neurological memory. But you didn’t learn French by trying not to speak English.

No, that’s very true.

Okay. So same thing with chronic pain. Remember, the default language is survival that your body’s first role. That’s what the anxiety response is for.

Yeah.

And if you’re going to try to fix that, where’s your attention? It’s on the chronic pain.

Yeah.

So the key is I call it learning a new language. I call it a new language; an enjoyable life.

Yeah.

Positive thinking-it’s when you’re suppressing negative thinking is a disaster- but a positive vision is absolutely critical.

Yeah.

Because what happens? What What do I want in my life? Create a personal business plan and execute it. With or without your pain.

Yeah.

So you start moving towards the vision, then you start moving away from the pain. Paradoxically, by not trying to get rid of the pain. There’s a much higher chance the pain’s gonna disappear.

Yeah.

So that’s what why have one of the basic rules is that never discuss your pain with anybody ever.

That’s interesting. Yeah, I didn’t pick up on that. I mean, I sort of speed read your book over the last sort of day or so. I didn’t pick up on that in the book. But it’s quite it’s an interesting idea.

So that’s the first book by the way, ”Back in Control”.

Okay. That’s why I didn’t find it.

Yeah. But that’s been huge. It’s been one of the biggest things we’ve ever done. Say ‘look stop!’ And the families get relieved. People start to relax a little bit.

Yeah.

It’s not that much fun for you, or the people you tell about your pain all the time. That also means no complaining.

Yeah.

Because Where’s your attention? Remember that mental pain is a bigger problem, the physical pain. And if you want to complain, guess what? Your attention is on the mental pain, right?

Yeah.

Also, no advice. Just listen. Okay no criticism.

Okay, I’m not following you. So this is the person who’s in chronic pain. Are they supposed to not give advice? Or are they not supposed to receive advice and criticism?

First of all, pain comes off the table.

Okay

Mental pain and physical pain are the same thing. So if you want to complain about whoever or whatever…

Yeah

…your brains on problems.

Yeah.

OK. So again, positive thinking’s a disaster. If something’s bad it’s bad. If you get to experience something unpleasant, it is what it is. But remember we’re creating a vision of where you want your life to go. And consistently making decision to be nice to people, regardless how they treat you, just get your brain moving in different directions.

This is not psychological it’s based on neuroplasticity. The language you want to learn is this enjoyable life.

Yeah.

Complaining doesn’t give you an enjoyable life.

No

So the key issue here, again, it’s not just the physical pain, there’s also the mental pain it’s a big deal. That’s where the no complaining comes into gear. No gossiping.

Yeah.

I mean gossiping’s not very helpful for anybody right?

No. Totally. Yeah.

Especially with the chronic pain, and I get it, I did this myself. This chronic pain has consumed your life. Nobody believes you, you’re bounced around the system, you’re extremely frustrated. And of course, when you’re trapped and frustrated your stress chemicals are even higher. So you’re feeling the pain even more, right?

Yeah. What you were just describing the kind of atmosphere the reason I’m laughing, not because it’s it’s funny, but you know, it’s something that I recognize.

If you look at Facebook groups, for people who have chronic back pain.

Right

You’re just describing the mindset of most of the people, or pretty much everyone in that group. They’re kind of angry, they’re kind of disgruntled, they want to complain, and they’re not really interested in any sort of positive message.

Right

You know
“Have you tried… some sort of mind mind body exercise? It worked for me.” The response is universally angry. They’re not interested.

Right. So here’s the problem. So anxiety’s this massive neurochemical response, not psychological, right?

Yeah.

Okay, so the answer to anxiety is control. When you lose control your body kicks in more stress chemicals in an effort to regain control. That’s called anger.

Yeah.

Anxiety and anger are the same thing. There are these irrational spinning circuits in your brain. I call them like little dust devils, which is little tornadoes in the prairie. But they’re obsessive thought patterns that actually block rational interventions.

Yeah.

Again it’s not psychological. This anger is an irrational survival circuit.

Yeah.

I’ll go back to the very first part of the discussion. So the essence of solving pain is connecting to your own capacity to heal. That allows you to feel safe. So when you feel safe, it changes your body’s chemistry to a very favourable environment compared and a threatening environment. But think about this also; is that anger also makes you feel safe.

Yes, it does.

Right. That’s why people don’t want to do it because if we give up the anger, we’ve unmasked the anxiety. So two things. First of all, it’s powerful.

Yeah.

There’s a lot of power in anger.

Yeah.

the biggest block, by far and away to treating chronic pain is anger.

Yeah.

And I won’t say it’s a lack of willingness to engage, but honestly, it’s part of the disease that actually blocks the treatment.

Yeah.

And it took me many years to figure this out is that I mean, I was so excited about people getting better. I mean, people come in and they’re pain free. But I didn’t realize that the power of pain was indescribably huge, and people become addicted to it.

And people don’t want to give up the support groups. We do a workshop back East every year at the Omega Institute. And one of the basic ground rules is you can’t discuss your pain at all. And people actually don’t know what to do. But literally 80% of the entire group goes a pain free within the weekend.

Because they’re in a structured environment. They’re having an enjoyable experience with other people. Pain’s off the table. And it’s remarkable how fast the shift can occur. Because remember, the antidote to anger is play.

Okay.

So on the website, we talked about the five steps, which is learning about pain, the expressive writing, active meditation, sleep, not discussing your pain. Stage Two is more complex is that remember it’s awareness, separation, redirecting. Forgiveness is becoming aware that you’re angry, forgiving, is letting go and play is moving forward.

Which is awareness separation reprogramming. [Okay.] So that’s why the sequence is sort of a basic starting point. If somebody doesn’t want to even hear about chronic pain, or engage, or engage in expressive writing, there’s honestly nothing I can do. Nothing.

You can lead a horse to water.

Right, exactly. So I found out that the more I tried, the more upset that they got. More upset I got it just was a very counter-productive discussion. [Yeah]. But I don’t honestly have the answer to it. And I’ve tried everything. And I have found out that I just, often I’ll just wait people out, and they’ll eventually come around. But um, but running up against ‘em headlong has never helped. It’s been a disaster.

Yeah, absolutely. Yeah. For me, the big breakthrough was when I accepted intellectually and a gut level. Do you know, there’s actually nothing wrong with my back, there’s nothing wrong with it. And when I….I didn’t get anywhere, as I said, with, you know, doctors and therapists, and what have you, I didn’t really make any progress at all, trying to have someone treat me.

And I kind of understood that exercise was, would be helpful. But for me at that time, you know, I was a young guy, exercise meant running, or hitting the gym. And I found that those activities when I was already kind of stiff, and you know, in in pain, they made it worse. But what I found was helpful was mind body exercise, where there was a focus on relaxation, and posture, as well as movement. [Right.] And this is when I really understood I can actually fix this myself,

Right. Well, there’s three parts to healing pain, first of all, is understanding the problem, which is true in any field, right? We have to understand the problem. So first of all, understanding your diagnosis is really critical, because I still do work ups. I wanna make sure I’m not missing a tumour or infection or something like that. [Yeah]

The second awareness is understanding chronic pain and what it entails and understanding the approach. The second step is that chronic pain is complicated. There’s many factors that affect pain, sleep, stress, physical conditioning, medications, et, all affect pain.

Every one of those is important so they all have to be addressed simultaneously. [Yeah]. And everybody’s different. So for some people sleep’s a big deal, probably 80%, but 20% aren’t. So what happens is that each aspect has to be addressed simultaneously and everything counts. [Yeah]

It turns out that many things work in chronic pain, but not in isolation. So it’s a combined approach.
Medicine right now has been throwing random simplistic, solutions at a complex problem. And it can’t and it doesn’t work.

But the third step, besides understanding, then treating every aspect simultaneously, the patient should take complete control. [Yeah]. Right.

This is a huge deal. When you realize ‘I can actually fix this myself’ It’s [right], very empowering.

Absolutely. That is the that is the biggest step in healing is taking complete control. And the book is not about believing. If you don’t believe anything I say write it down. Hanscom’s a charlatan. He doesn’t know what he’s talking about. That’s fine.
So it’s not about believing that you’re going to be better going to be better it’s actually about connecting to what is. In other words, you’re connecting to your own capacity to heal. Which means you can connect with everything the dark side the bright side. Whatever, is there, you’re connected to it. [Yeah].

And so all we ask people to simply start the writing exercises, which by the way is not the solution but definitely the starting point that starts breaking up these circuits. And I feel very challenged that’s one of my biggest pursuit is how do you break through to people that are so angry that they can’t hear you? [Yeah,] Don’t know how to do that.

Maybe it’s just one of those things in life that’s not possible.

Well, yeah, and this is getting super idealistic. I mean people come up with the word world peace so actually even the only block to world peace is that same thing.

Just one is to actually listen. [Yeah]. Because when you’re angry is destructive. Remember anger is an effort to regain control. [Yes]. Anger is only destructive, including self destruction.

So it keeps you safe. But what so the way I kept myself, by the way, in the victim role, I mean, I still do it every day it’s such a powerful role that nobody ever wants to give it up.

One of the basic roles, but particularly for physicians is being a perfectionist. [Okay.] Now the genealogy of anger is the circumstances that you blame, then you’re a victim, then you’re angry. [Yeah.]

So I think the reason why perfectionism, perfectionism exists is because of the need to stay in a victim role. So you blame yourself in the situation-being less than perfect. You’re blaming yourself for being less than perfect or the situation, you’re always a victim of less than perfect, and you’re always agitated.

So it feels powerful; to keep pushing you and driving you. It blocks the feeling of anxiety. But at the same time that I didn’t actually feel much anxiety, if any at all. My ears were ringing my feet were burning these skin rashes were popping up. And I didn’t connect this chain of body chemistry with the symptoms I was having. I had no idea what was going on.

You can you can block the feeling of anxiety by staying angry. No question about it. The problem with anger is that when you’re complaining together there’s sort of an intimate feeling right? [Yeah, absolutely. Yeah.] People call it ‘woundology’, whatever you want to call it.

But yeah, also research shows when the biggest prognostic factors for a poor outcome in chronic pain is actually keeping a pain diary and belonging to a pain support group. [That’s interesting.] Now, if you belong to a pain support group that never talks about the pain, and simply discusses how to move forward and supporting each other, that’s wonderful. [Yeah,] That works beautifully. In fact we do that. [Yeah].

But if it’s a support group, that only is, not even only complain, but is spending even a third of the time, discussing the pain and complaining, it actually doesn’t work. Because you’re really reinforcing the pain, pain circuits.

That makes total sense. Yeah. One of the things that really struck me is, you talked about your early career, and becoming an orthopaedic surgeon and a specialist in spine surgery. And then going from there to a complete sort of about-turn on your views about the source of back pain, and the efficacy of what you what you do as a professional. That must have been very, very difficult.

Well, it’s a really tough story for me personally, and I’m grateful I can share what I learned, but I’m not very happy I went through it myself. But what happened is, I came from a .……… spine fellowship, we came, I came to Seattle, which had nine times rate of spine fusions per capita as the East Coast.

And for seven years, I was doing spine fusion, after spine fusion after spine fusion. And I kept asking people, what’s the data? How do these things work? Well, nobody could tell me the data. And then in 1993, a paper came out of Washington to show that the success rate every spine fusion for back pain at 2 year follow up was 22%.

And this is a big operation. So I was thinking 90% [Yeah,] most people 75% success rate start to balk at the outcome. And 50% most people won’t do the surgery. But at 22% I just stopped doing them. [Yeah], But I didn’t know what to do.

But I understand that was kind of standard practice. And maybe still is still how, how has that situation arisen? It’s horrific.

Well, it’s a whole different topic about the business owners. [Yeah,] We’re doing more fusions now than we’ve ever done. It’s horrible. But again, there’s still not a research paper out. I mean, literally, I have talked to several friends of mine said, ‘Look, this is sort of like frontal lobotomies. We’re in the 50s.’ Because there were 1000s of those things done. And then a friend of mine who actually used to do the frontal lobotomies, and he said, “Well, at least they worked”. They did. They called it dissociative phenomenon where you felt the pain but you didn’t care. They worked. Now that’s not great, but it worked.

With back pain surgery, it actually doesn’t work at all because it doesn’t hit 20% isn’t isn’t even a good placebo response. The data also shows when you operate in the presence of chronic pain that you can induce or make it worse 40 to 60% of the time because those pain circuits are already fired up.

You start plugging in body parts [Yeah,] you actually have double the chance of making it worse than you have actually making you better.

First, do no harm isn’t isn’t that the Hippocratic Oath it’s something that isn’t it?

In, at least in our country, the business of medicine has come in and made things very very predatory for patients and I don’t know exactly what to do to change it.

I actually quit my practice at it’s peak. I am writing the book, I’m giving lectures or doing podcasts. I’ll do whatever I can do to actually change the tide.

It became really difficult for me to so instead of doing one to 2 level fusions like I trained to do. We’re now doing 8,10,14 level fusions. And fusing the entire spine. So it’s considered as just one level. The complication rate that situations over 60%. Horrible complications.

Wow. And how’s the spine going to work? If you do that to it? It’s going to be like a sort of lamp post isn’t it?

It’s horrible. It’s really bad. So I just couldn’t do it any more, honestly. And I don’t know how from I don’t know how far I’m personally going to be able to take this project. But I’m going to give it my best shot. It’s all I can do.

Yeah, sure. And you’re not alone. You’re not the only person to kind of notice this.

There’s not many in the surgical world. I will say that I mean, there’s there’s, it’s not really well accepted to put it mildly. [Okay,] so I take a tremendous amount of heat for this whole project. But, again, mainstream medicine is throwing random, simplistic solutions at a complex problem.

Essentially, every treatment we offer in spine care has been documented to be ineffective. [Yeah,] So the shoe’s actually on their foot to prove that it works.

Everything in my first book back in control, also, in the second book has been documented by deep medical research literature for decades. What we’re doing in medicine right now, it’s been not been documented by anything. [Yeah.] So really the shoes on their foot to prove what they’re doing works. [Yeah.] But again, business and medicine with their first modality being talking to the patient. That is a proven healing modality. That’s been taken away. [Yeah.]

Shocking. Yeah. Okay, well, I see the time now is two minutes to nine here two minutes to I think midday where you are. So you said you had another call to attend to. Is that right?

I do have to go at noon, so yeah, yeah. Again, I’d love to, if you get a chance to look into the books. There’s, as you can tell, there’s family issues we haven’t really touched on. There’s, there’s lots more details about spine surgery itself that I’d be happy to talk about. So yeah, I’d love to talk to you again.

Okay. All right. Well, great stuff. Fascinating. To hear you go into a little more, little bit more detail, and explain the book and yeah, lovely talking to you.

Yeah, thanks a lot. Appreciate it. Talk you soon, bye bye.

Transcribed by https://otter.ai