Book Report: Back in Control: A Surgeons Roadmap Out of Chronic Pain

Back in Control: A Surgeons Roadmap Out of Chronic Pain by David Hanscom MD

A renowned back surgeon, that thru his own experience, no recommends non-surgical pathways out of pain.

Dr. Hanscom, a practicing back surgeon in the Seattle area, had a series of difficult experiences he described as a tailspin leading to significant pain and a path to surgery. Luckily, he found a book that recommended expressive writing exercises. These are most simply described as 15 minutes twice daily of writing all thoughts onto a paper, and then tearing them up.

This process helped what was described as NPD (neurophysiologic disorder); defined as “When you are under stress for any reason, all of the fifty trillion cells in your body are bathed in adrenaline, cortisol and other stress chemicals, and each organ system will react in its own unique way. Consequently, there are over thirty physical manifestations of this situation.” NPD causes an experience of painful symptoms whether or not you are injured by triggering nerve pathways and hormonal responses.

Negative self-talk was also described as a factor and negative framing in general. Here are a few quotes relevant to this:

• The brain is programmed to look for danger and will first focus on negative judgments.
• Burns calls these negative thoughts “ANTS,” which stands for “automatic negative thoughts.”
• Then there is the error of “labeling.” For example, a frequently late spouse becomes “inconsiderate.” A forgetful teenager becomes “irresponsible.” By labeling, especially negative labeling, you can no longer see them because you are only projecting your version of reality onto them.
• Laboratory studies have revealed that that the brain actually shrinks in the presence of chronic pain. It makes sense to me that if much of your brain is stuck in repetitive negative thought patterns, other areas—the ones connected to time with family and friends, enjoyable experiences, etc.—will atrophy. Additionally, adrenaline decreases the blood flow to your brain, which could be a factor.

Degenerative Disc Disease is often citing as a reason for back pain and resultant surgeries. What Dr. Hanscom finds in the operating room is that degenerative discs rarely correspond to pain levels, and at some point in the aging process 100% of people have some kind of degeneration. He conveys that while there are certainly reasons to do surgery, they are far less common than the rate at which procedures are performed currently and that the mental pieces above should be evaluated first in all cases.

Where to start:

Here is an overview of the five steps:
Step 1: Learn About What’s Affecting Your Pain (Awareness) •Confirm your diagnosis •List how many NPD symptoms you are experiencing. •List the factors affecting your pain −Sleep −Stress −Medications −Physical conditioning −Life outlook
Step 2: Begin expressive writing (awareness and separation) Step 3: Practice active meditation (reprogramming)
Step 4: Don’t share your pain (reprogramming)
Step 5: Sleep (reprogramming)

I read this book the day after a patient said she was going to seek some kind of neck surgery that was diagnosed as a degenerative disc. I knew there were contributing factors, such as those listed above, but after a little research to help deploy a solution I came across Dr. Hanscom’s book. We put the expressive writing into practice immediately. It started paying dividends soon after, and I am happy to report that surgery was declined.

The writing piece is not difficult, but meditation and sleep quality implementation are something that requires a little help in most cases. Part of the certification for HPC training involves medication, and I practice daily (And have helped others do so as well). Further, sleep is a recent obsession of mine. Using a sleep tracker, and reading lots on the subject, with a bunch of trial and error, I am very proficient at obtaining excellent sleep; not measured by hours in bed. I would be happy to partner with you to implement these tools and evaluate if we can reduce the chronic pain experience!

This Book Report collection is meant to provide some of the best take-home points from the health and science genre I read. I will continue to go thru my notes of the 160+ and counting (as of January 2019) Kindle books I have on file. To view ALL the notes I saved on this one AND many others without a Book Report post yet, THAT IS ALSO SEARCHABLE, please click here.