Yeah, so we we kind of got in touch a couple of days ago, because I was interested in in a book that that you’ve written and it’s just being released in a new format in paperback on Amazon in October, which is ”Do You Really Need Spine Surgery? Take Control with a Spine Surgeons Advice.” And you kindly sent me a draft copy of that which I’ve just been looking at over the last couple of days. And I have to say it kind of blew my mind right from the very beginning.

The reason being is right in the in the forward of the book, you describe what you say is a common scenario where spine surgery is recommended or performed on anatomy that’s not a source of pain. And in such cases surgery, not only is it effective, but often it makes patients worse. And you describe someone I think you said his name is either Sachit Sach Egan and he described his experience with a surgeon who was basically aggressively pushing surgery on a very short time schedule. It was almost like a high pressure sales technique. And that was… I found shocking, actually.

Right. Well, like we talked about before is in America, we’ve gone very production based. And I think medicine in our country’s become dangerous for the patient. It makes no sense to walk in a certain office, the surgeon doesn’t know you. Pain is a complex problem. And the neuroscience has shown that acute back pain is completely different than chronic pain.

Sach, he is a gentleman who was young in his mid 20s. He had a condition called spondylolisthesis. His spine was stable. It was not the source of pain. And he three different surgeons on the first visit recommend urgently that he gets surgery.

I’ve said this is sort of a joke for a long time that the biggest risk of having a spondylolisthesis is having a surgeon recommend surgery with spondylolisthesis is there’s a little bit of a bony defect in the back part of the spine called the lamina. But the vertebrae takes 85% of the force, that defect is just there. It’s never been proven to be a source of back pain. It only becomes a structural problem. When its pinching nerves causing sciatica. That’s a different ballgame.

But back pain should never be the reason to do surgery for back pain in general and in particular for spondylolisthesis.

And he had a lot of anxiety, he was very stressed out, he worked for a very high powered company. He was very competent, he was young having some relationship issues. Anyway, over about a year with three or four visits, he started reading my other book called ”Back in Control: A Surgeon’s Roadmap Out of Chronic Pain. ”Within year not only not only was he pain-free; he went back to an extremely active lifestyle with no limitations at all, and no back pain.

The contrast is pretty stark, where you have somebody who’s now about 30. Absolutely no limitations, no back pain, minimal anxiety absolutely thriving. Compared to having surgery, which we know actually doesn’t work for the situation.

It has about a 40% chance of making it worse, then the spine starts breaking down above it. And I’ve had patients start with surgeries in their 20s. And over next 10 or 20 years have 20 or 30 surgeries as a spine starts to break down above the fusion.

So the contrast is quite stark in such a case, unfortunately it’s not unusual it’s pretty much the norm now where major surgical decisions are being made on the first visit many times.

So this is what you call the juggernaut of aggressive spine surgery.

Right. I’m not sure what happened in our country, you know, United States right now is a lot of chaos as far as financial and just the way we look at things…with the school system prison system, businesses, medical system is really very much driven by profits.

And in the medical system in general, the business, the business message came in a very powerful way about 15 years ago, the last five years they started hiring physicians and literally forcing them to see more more patients and less time. Listening to your patient is the essence of being a physician. If you don’t really know your patient, you actually don’t know the situation. The problem that’s being missed by everybody is that we under situational stress.

It changes your body’s chemistry. So you’re full of adrenaline, cortisol histamine, it doubles the nerve conduction. The animal studies show that when you’re under this chemical environment, your nerve connection is doubled. You feel the pain more. And just by getting to getting people through their situational stresses. It changes the pain threshold and pain. Usually, not occasionally, the pain almost always disappears.

Right. This kind of flies in the face of the way most people think about pain, isn’t it we normally think of pain as being, as resulting from damage, physical injury, some actual physical problem causing that pain. But you’ve you kind of rejected that idea. In your book and in your life, I suppose.

Well, I was trained like everybody else. We were focused on quote, The pain generator. In other words, if we cut out the source of pain, we somehow solve pain.

What I’ve since learned, which actually is common sense, but also clearly been shown by neuroscience research. Pain, just says danger, just signals danger. And it’d be looking at a bright light and the sun. Saying ‘Well I shouldn’t look at this.’ Or the sounds are too loud. or something’s too sharp or too cold.

To look at the pain threshold of an NFL football player or in your field, I guess rugby or a boxer or fighter, whatever. Their pain threshold’s a lot different.

In other words. If I had a fraction of the force applied to my body that these boxers do, I wouldn’t tolerate it at all. So I mean, it’s the same pressure and I’m feeling the pain and this boxer male or female is not feeling the pain. Why?

Because the brain is what determines whether something is dangerous or not. So if something is not a danger, there’s no pain signal that’s going to be given off. So pain is the result of input it’s not the cause. The only pain generator that exists in the body, by the way is the brain. The brain has to process sensory input. And says danger, then you feel the pain.

Yeah. And people have a real problem with this idea. Don’t they? And this is, people just find that really hard to believe. I’m feeling all this pain, it is not all in my head, there must be some….there’s something seriously wrong my back because it’s hurting this bad.

Well again, where are the signals coming from? Okay, so the signals have to go up your spinal cord to your brain, your brain unscrambles the signals, says this is painful.

But one of my friends pointed out very succinctly, the reason why your brain puts out the pain signal is for survival. Because, remember, pain is your protection.

In fact, there’s a diagnosis called congenital indifference to pain where people are born without pain fibres. They can only survive about eight to 10 years because they can’t protect themselves. They put their hands into the fire, they walk on coals, they don’t know under how much pressure to use to protect themselves.

Pain is incredibly necessary part of survival. If you don’t have it, and they did all sorts of research trying to substitute some mechanical device for the pain system, they can’t do it. Because it’s not logical to say that pain is sort of caused by something in your body. It has to be, these sensory impulses have to be interpreted by the brain. If you look at the sun too long, what does your brain tell you to do?

Look away, I suppose.

Right. Cos if your brain didn’t tell you to do that, then your eyes would be sizzled, right?

So acute pain and chronic pain and completely different. And what happens is that it’s called acute pain or nociceptive pain system. Every part of the body is linked to this nociceptive center, what it does, your brain processes 11 million bits of information per second, your conscious brain processes 40. Okay,

So right now as you’re talking to me, your jaw muscles are moving because your brain coordinates the tongue, the jaw muscles, etc. Your hands move, because everything’s coordinated. You’re unconsciously moving around in your chair. So as to protect your skin, your pupils are being dilated, constricted, automatically is all being done by the unconscious brain.

So that’s 11 million bits of information per second. The rational brain processes 40.

What this the unconscious brain does, it keeps you in a range of behaviour that’s safe.

The species of creatures over millions of years that didn’t pay attention to these visual cues. I’m sorry, the sensory cues didn’t survive. So it turns out that this species that’s alive right now, after survival of millions of years, are the most anxious species.

So it was called the Nociceptive systems when you feel pain means you’ve exceeded the safe limits of your body. Your brain says danger, then you have to take evasive action.

But humans have a major problem called the curse of consciousness. Where a mental threat is processed in the same part of the brain as a physical threat. You get the same chemical response. Except humans can’t escape their thoughts.

Okay, every human being has sustained levels of stress chemicals based based on our inability to process our thoughts. It’s part of the unconscious survival response.

So even though thoughts are only 40 pieces of information per second, you set off this massive response. That’s 275,000 times stronger than your conscious brain.

The sensations in your body with these stress chemicals is called anxiety.

I say, Look, don’t use the word anxiety any more. Just use elevated stress chemicals. So what happens if you feel anxious? The way to decrease anxiety is actually decrease stress chemicals.

So if you’re experiencing pain, you take your hand away from the source of the pain, anxiety drops or the stress chemicals drop. But what do you do with your thoughts? You can’t escape them. And that’s what the first book I wrote is all about. It’s called ”Back in Control: A Surgeon’s Roadmap Out of Chronic Pain.”
It turns out the mental pain as manifested by sustained elevated stress chemicals, or anxiety, is a much bigger problem than physical pain. Much bigger.

If I give people the choice as a surgeons. Say

“Look, I can get rid of your pain with surgery and you get to deal with you’re anxiety of the rest your life or get rid of your anxiety, and you have to deal with the pain.” The vast majority people want to get rid of the anxiety.

They can’t tolerate the anxiety and how this whole process evolved, I was a major spine surgeon. I was fearless. I went to one of the top spine fellowships in the world. I didn’t get there by being a wimp. I got there by suppressing anxiety. Which is a problem, right?

So all the all sudden at age 39 I went from no anxiety to panic attacks. Then what happens with the sustained stress chemicals they translate into physical symptoms because each organ is now in a different chemical bath. I had 17 of these over 30 symptoms at the same time for over 15 years, which is a really long time. So I had ringing in my ears, migraine headaches, tension headaches, crushing chest pain, stomach issues, back pain, burning in my feet, skin rashes would pop up my scalp would itch I mean just went on and on and on.

Remember when your body’s subject to sustained exposure to the stress chemicals or stress hormones adrenaline cortisol histamines and chemicals like that. Each organ is going to it’s like driving a car down the freeway in second or third gear, your body’s going to break down.

And indeed We know that chronic stress right there’s a study out of Sweden. And that was done about two months ago, it demonstrated a very strong link between autoimmune disorders and chronic stress. And that includes rheumatoid arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, all these are autoimmune disorders.

What happens is stress chemicals change your histamines, cortisol levels and it creates an altered immune response. So there’s a first very clear link between chronic stress and autoimmune disorders. We’ve known for 50 years or longer, that people under chronic stress die about seven years earlier.

They have double heart disease rate, high depression, obesity, suicide, I mean all these things happen because, it’s not psychological, it’s your body chemistry’s off.

So you have this massive survival response compared to your rational brain. And in one of my website posts next week called by the way, my website’s is backincontrol.com, which will be which will be linked to both my books do you really need spine surgeryy and also back in control. But is anxiety your body guard or your prison guard?

Because we didn’t have anxiety, we couldn’t negotiate new challenges. You couldn’t walk out of this, walk out the door without, you know being hit by a car. We have to have anxiety to survive, right?

Anxiety’s your body guard and is necessary and allows you to do all sorts of things in life. But if you attach your identity to it becomes a prison guard. In other words, the size of our lives are really limited by the amount of anxiety we can tolerate. And if you separate it from this massive survival response, you can do whatever you want you’re a free person.

The key issue of healing chronic pain, is connecting to your own capacity to heal, which allows you to feel safe. When you feel safe, then the body chemistry has a dramatically different makeup than when you feel threatened. Right? Then your bodyily chemistry changes dramatically. Your pain threshold changes dramatically. Pain goes away.

So it turns out that chronic pain is actually curable and solvable. Not just to be managed.

So I segued from the point I was trying to make a few minutes ago and I apologize for that. Is that acute pain and chronic pain and completely different.

So acute pain is part of the nociceptive system, which keeps you in a range of behaviours and keeps you safe. What happens in between six to 12 months, acute pain, it becomes chronic it actually shifts to a different part of the brain; shifts to the emotional centre. So you have the same back pain but a different driver.

The current definition chronic pain is that is a memorized set of circuits it’s an embedded memory, that becomes connected to more and more life experiences. And the memory can’t be erased. So it is it’s like phantom limb pain, where you have the leg cut off, you still feel the pain.

And so it can happen to any part of the body. So with chronic back pain, again, your brain’s memorized the pain it’s in the emotional centre it’s connected to more and more life events.

That’s why when stress happens, a pain goes up for two reasons. First of all, it’s linked. neurons that fire together wire together, but also body chemistry changes. So that’s why, when you’re under stress is not psychological is neuro-chemical that makes the back pain worse.

The worst part and the reason why I wrote this, actually I quit my surgical practice, because probably 70% of spine surgery should not be done. I’m a complex with a call salvage surgeon, and people come in to me with multiple surgeries. And I kind of was trying to salvage that surgery.

And it took me many years to figure out well guess what, I could do the surgery, but the pain wasn’t going away. So before I do any surgery, now I do what’s called pre rehab, where we get people relaxing. If you look at my website backincontrol.com, There’s four stages.

In just in stage one, the whole process is calming down the nervous system. And so as you calm down the nerve system for eight to 12 weeks, I had over 100 patients with surgical lesions that they cancelled the surgery because their pain disappeared. I literally put myself out of business, I had to make a living off elective surgery alone, I couldn’t do it. I only operated about four to 5% of the patients that came to my door because the pain simply disappeared.

So the book was written is that probably 70% of spine surgery is being done on spines that are normal for people’s age. We know very clearly for instance I’ll just talk about one of the surgeries, which is back pain for degenerative disc disease. It’s been well documented that disc degeneration, bone spurs, arthritis, bulging disc, none of those cause chronic back pain, right? None of them. We know that.

There’s not one research paper if you look at chapter I think 10 or nine of my book, this last chapter to just summarize the literature on on back pain surgery is not one research paper in 50 years that says that it works. But we’re up over $40 billion a year on doing spine surgery for back pain.

You’re taking a relatively normal spine actually taking a normal spine for persons age. And so the research says disc degeneration doesn’t cause back pain. Instead of being called degenerative disc disease, it should be called a normally ageing disc. So your spine’s stiffer, but doesn’t mean it’s more painful.

And people come to me all the time with sciatica, bone spurs all sorts of stuff. With leg pain. The back doesn’t hurt. So that’s one of the elephants in the room. I’ve had 2 back surgeries myself. My spine is a mess. No back pain, knock on wood.

But this happens pretty much every day in clinic people come in with sciatica, and horrible looking spines, but no back pain.

So that is also one of the biggest reasons we do spine surgery.

We’re taking a relatively normal spine, not at 20 years old, but for a 50 year old person it’s a normal spine. We’re welding together with bone graft. There’s no data, there’s not one research paper in 50 years, that says that it works this upwards of $40 billion a year of surgery. It makes no sense.

Then another paper says that only 10% of surgeons are actually acknowledging the risk factors that we talked about that make pain worse. For instance lack of sleep is number one. There’s a study out of Israel that shows that lack of sleep actually induces chronic pain up to 40% of the time.

I’m sorry, take it back. It shows that lack of sleep induces back pain period. They didn’t find the reverse causation where chronic pain causes lack of sleep. So the number one thing is getting people to sleep. That’s never addressed by surgeons. Again, the research shows only 10% of surgeons are actually addressing these risk factors before they do surgery.

As in Sach’s story, major recommendations for surgery are done on the first visit. We also know that when people are under situational stress. And they are. Your body chemistry of course is going to be off, this changes the nerve conduction, changes the pain threshold.

If you just wait it out and find out who these people are, what’s going on in their life. Have them write it out a little bit. pain goes away. Vast majority of the time. I actually quit my surgical practice because I saw so much of this happening every day, at least three to five times a week in clinic. I see patients with really bad things being done to their spines. When I look at the preoperative films, they were fine. There’s nothing, nothing there to operate on.