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When someone in our family experiences pain or needs surgery, we immediately think this would solve the problem. But sometimes, too much surgery needs to be done to fix something, and it's not going to be easy. We would spend a lot of dollars to cure it. Listen to your host Pamela Wirth as she talks with Dr. David Hanscom about conquering pain without surgery. Dr. David Hanscom practiced complex orthopedic spine surgery for 32 years. He eventually escaped from the ordeal and discovered that mental pain is the biggest issue. Anxiety is the pain. Therefore, we must understand a problem so we can deal with it. Tune in to learn how to make better decisions and fight unpleasant symptoms and illnesses.
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An Orthopedic Spinal Surgeon’s Take On Conquering Chronic Pain Without Surgery With Dr. David Hanscom
Back In Control - The DOC (Direct Your Own Care) Project
In this episode, I have Dr. David Hanscom, a spinal surgeon and orthopedic surgeon. Tell us a little bit about yourself.
Thank you for having me in the program. I'm an orthopedic spine surgeon. I have practiced complex spine surgery for many years. My practice was the end-of-line practice. I was considered one of the salvage surgeons in town. There are five of us. I would get patients who are at the end of the line, with multiple operations, and some people with 10 to 20. My record is 29 operations over 20 years. Once you have a failed spine surgery, it is devastating.
I ended up looking back at the original films. A high percentage of patients never needed surgery in the first place. They started with an operation they did not need, and their spine started to break down. We have 20, 15, or 10 operations in your life and it starts destroying your entire life. I quit my practice in 2019 to show people how to heal chronic pain without surgery. We've had a lot of success with that.
Tell us a little bit about how you are doing this now. I believe you've got an educational series. You've got a book. Tell us a little bit about how you are helping people with this.
I spent fifteen years in chronic pain myself. I did not know what hit me. I went to multiple doctors. Nobody could tell me the answer. Like most patients in chronic pain, I lost hope. What I didn't realize back then is that mental pain and chronic physical pain are the same entity. They're processed in the same part of the brain.
I developed seventeen different physical and mental symptoms. I didn't realize I went from a fearless spine surgeon to crippling anxiety in a day. Once that lid came off the pot, I could not put it back in place. I ended up with crippling anxiety for fifteen solid years and got lucky coming out of it. I wrote a book in 2012 and the second edition in 2016 called Back in Control: A Surgeon's Roadmap Out of Chronic Pain.
If you see a surgical problem, it can be solved by surgery, but sometimes, there's so much surgery to be done on.
It reflects my journey crawling out of this hole about a millimeter at a time. I started to work with patients to find out what worked and didn't work. When I quit my practice, I wrote another book called, Do You Really Need Spine Surgery?. Spine surgery is not that hard to decide what to do. If you see a surgical problem, it can be solved by surgery, but there's so much surgery to be done on normally aging spines that it can't help.
If a spine is normal, how can you turn it into massive scar tissue on bone and have it help? I wrote the book called Do You Really Need Spine Surgery?. It's intended for patients to make better decisions and also to make sure they're accountable to their patients and other providers because surgeons make these declarations about what should be done, and nobody can argue with them.
My goal is to create accountability with this book. I'm not trying to stop surgery. I'm just trying to stop serving on normally aging spines. What's happened was I have had hundreds of patients get better with my first book, Back in Control, and my website, Back in Control. What has evolved over the last few years is called The DOC Journey, which is a computer-based course that goes through a sequence of getting people to learn the principles and starting to learn tools to calm down the nervous system. It's a much more efficient, effective way of getting people to heal more quickly. That's called The DOC Journey, Direct your Own Care Journey. It's self-directed. We often layer on resources, but as opposed to jumping around and trying different resources, it's more of a thoughtful, layered approach.
All it does is reflect the deep medical science of how to treat chronic disease. That's in place. We also have an app called the DOC Journey, which is based a little bit more on workshops. It's quite entertaining. My wife took the project over. She said what I was doing wasn't an app. She was right, but it's got the vision boarding, juggling scarves, all sorts of stuff. When you're at play and relaxing, it changes your body's chemistry.
That's more of the app approach. Both are effective. It depends on what you connect to. I'm going all over the country, giving speeches, talking to people, doing public appearances, trying to get the world to say, "Medicine's hurting you. Stop." I try to talk to medicine saying, "Quit hurting people." I'm on a mission to do what I can do. I realize the problems are way bigger than I can. I made lots of errors in individual people's lives, but I'm probably not going to change this juggernaut of medicine anytime soon.
It's pretty exciting, the thought that you can control your own destiny with pain here. You're trying to help by not doing unnecessary surgery, but there's a lot of opioid abuse. That's certainly a step in the right direction as well. What are some of the types of pain that you've had success with your patients? What things are they experiencing?
When people ask that question, what we forget about is what chronic pain is. Any signal that comes into your body that's unpleasant should be considered pain. Too bright, too loud, too sharp, too dull. What happens is that it turns out that every chronic disease, every one of them, has the same root origins, with cell dysfunction, genetic dysfunction, and inflammatory markers. What happens is you have this same response that causes every disease. It turns out that anxiety, depression, OCD, bipolar, and schizophrenia are all inflammatory disorders, every one of them.
You then have Alzheimer's, Parkinson's, cardiovascular disease, peripheral vascular disease, obesity, hypertension, and diabetes are all inflammatory disorders, and so are osteoporosis and cancer. What happens when you're under sustained, I call it threat physiology, where your body attacks itself. It turned out that at the bottom of this cascade of dysfunction, there's a sequence that creates all these different chronic diseases. They're all the same thing.
Let's talk about symptoms. Back pain, neck pain, and pelvic pain are all chronic pain syndromes. That type of thing is all inflammatory. I had seventeen symptoms at the same time. I had ringing in my ears called tinnitus, migraine, headaches, back pain, and neck pain. I had a burning sensation in my feet. I had a compulsive disorder, anxiety, and depression. These symptoms would pop up over my entire body off and on. It comes and goes quickly. When your body's full of stress chemicals, all these symptoms pop up, mine are all gone. There are multiple symptoms, physical and mental. We think mental pain is a much bigger problem than physical symptoms, even though neither one is great.
When you're struck with all these different symptoms, you're miserable. You're trapped. There are two research papers that show that the effect of chronic distress is the same effect on your quality of life as having terminal cancer, except it's worse because you know the diagnosis. You know it's wrong. You know the prognosis is either good or bad. Either way, you know what's going on. Not knowing the problem, not knowing the solution, and not seeing your way out are incredibly devastating to people's psyches. It's horrible.
How long, on average, do people need to be in the program before they can start to feel better?
Everybody's different. We call the term dynamic healing. Let me go to the essence of the problem again. Most people think that stress is a psychological construct. It's not. Every living creature has to process the environment in a way to stay alive. Stress is your threat. This a bad boss, a bad marriage, whether it's a physical illness, that's all stress. There are positive stressors, like a new job, getting married, moving to a new location, and all these different things. Those are all stresses. Stress is the input. What happens is you have your stresses or circumstances. I call it the input. You have your nervous system, which processes these signals from the environment. The output is your body's response.
We found out that mental pain is much bigger than physical pain. And the reason for that is that you cannot treat physical symptoms without treating mental pain.
If your brain's signals are okay or you're handling the stresses all right, then you're in neutral or what we call a stand-up safety. If your brain senses danger, you immediately go into a fight or flight response, which is adrenaline, cortisol, and inflammatory proteins, and your metabolism or fuel consumption goes up. The essence of all chronic diseases, both mental and physical, is sustained exposure to stress chemistry. The essence of healing is teaching people how to regulate their physiology from threat to safety. When I say the word physiology, I mean how does the body function? A car sitting by the side of the road has no symptoms. It's just sitting there. It's when you turn the car on to see how it runs. That's the physiology of the car.
Blood pressure, temperature, respiratory rate, and muscle tension are all regulated automatically. That's called physiology. Under sustained threat physiology, your body starts to break down, and it does. It's been well-documented that sustained stress causes early death. All these things I just mentioned, heart disease and cancer, all happened under sustained stress. Chronic stress is the problem. Stress is just a signal. The problem is the physiologic response or the stress response. It's the response to your stresses that cause the problem.
In terms of audience, who do you find is best equipped to take the course?
Anybody. What's happened now is that we found out that mental pain is much bigger than physical pain. The reason for that is that you cannot treat physical symptoms without treating mental pain. What happens is that humans have a major problem called consciousness. My cat has a stress response where her hair flies up, screams, yells, and runs away. Humans do the same thing. We have a physical threat. We get out of there or solve our problem, and the problem is resolved. The problem is our thoughts. Unpleasant thoughts create the same effect on your brain as a physical threat. Unpleasant thoughts are a threat. Suppressed negative thoughts are even more of a threat. Humans can't escape their thoughts. Every human being has an issue with sustained threat response.
The sensation generated by that physiology or that state of hyper-alert is anxiety. Anxiety is a physiological state. It is not a psychological diagnosis. The real kicker here is why we're having so much trouble with chronic disease is that we try to get rid of the word anxiety. It is activated through our response, and when we solve the problem, the response drops down. If you're trapped, your body kicks in more of a stress response, and you become angry. Anxiety and anger are the same things. It's just a matter of degree. The major problem is that this threat response processes about 40 million bits of information per second. That's a lot.
The conscious brain processes 40. Forty million versus 40 is a 1 million to 1 ratio. You're not going to solve this survival response with rational means, number one. It's a complete mismatch. If you didn't have anxiety, how long would you survive? Not at all. Anxiety is a gift. Anger is a gift. We don't view it that way. We feel bad about ourselves if we feel this way. It's about yourself. It's about survival. It feels bad as supposed to feel bad. To try to counter that with rational means can't work, and it doesn't work. In this sustained threat response, we have this massive epidemic of chronic disease.
Essentially, every chronic disease is driven by trying to avoid the survival associations that humans cause anxiety. Anxiety is the driving force behind human behavior, avoiding the association, but also the same force that creates all these diseases. I'll ask you a rhetorical question that you're not supposed to get the answer to. You might. I want people to think about this. Did I explain clearly now that stress is not psychological?
It's still going to be hard for people to accept that, but yes.
Think about it. I'll talk to your audience again. Stress is a threat, whereas thoughts are also the same threat. What's even worse is that suppressed unpleasant thoughts are even more of an effect on your physiology than expressed thoughts. Whether you think the thoughts or suppress them, you're in trouble either way. I liken it to spinning a basketball on your finger. If you experience the thoughts, they get worse. If you suppress them, the basketball spins even faster, and then the brain memorizes them. I call it phantom brain pain, but the brain memorizes everything. For instance, chronic low back pain. First of all, we know lack of sleep causes chronic back pain.
It doesn't have to be an injury. The problem is lack of sleep is inflammatory. You have back pain, and then they find out when the pain center of the brain, there's a certain spot that correlates with back pain. After 6 to 12 months, that center shifts to the emotional center. Unpleasant thoughts are sensory input, emotion to what you feel. In other words, emotions reflect the body's physiology. Your circumstances, your threats, and your situation are stresses. Stress is what's coming into your brain, called the input. For instance, you could be calm or hypervigilant, and your physiology could be either calm or activated. We call it dynamic healing.
In medicine, we're treating just the symptoms. We are not making patients feel safe. We teach ways to help patients give their bodies cues of safety, which allows them to drop it on the physiology. Going back to the question that you're not going to be able to answer is that if anxiety is this total body responds to stress. It's not subject to rational control. How do you lower anxiety? It's a trick question.
It sounds like a lot of exercises need to happen to create that muscle memory to bring down that response that many of us are used to going to.
Any signal that comes into your body that's unpleasant should be considered pain.
What you're doing is you're simply lowering the stress chemicals. That's it. You can do it through breathwork, exercise, and better sleep. All you're doing is trying to lower your stress chemistry. Remember, anxiety is a sensation generated by our stress chemistry. As you learn tools, it solves our problems. We call it giving yourself cues of safety. The most damaging stress is the stress that you can't control. People say, "We'll do stress management." That's not the problem. If you can't manage the stress, people manage it. It's the stress that you can't control that's a big problem.
A lot of us love being in control. How are you able to manage situations that you can't?
What you learn to do is learn to think about the need for control. In other words, you're not going to control the survival response. I talk about developing a working relationship with it. The anxiety and anger do what it's supposed to do. They protect you. It doesn't feel good, but there are ways of processing it quickly. You drop it down. It occurs multiple times every day. It's a dynamic process. You learn to regulate your body's chemistry. You spend most of the days not being in a fight or flight. People think, "I'm going to get cured of anxiety." You must stay alive. It's a gift. It's a million times stronger than your conscious brain. You learn to separate your identity from this survivor reaction. You learn to develop a working relationship with it.
What happens is your conscious brain is free to move in the direction you don't want. If you're using life experiences for pleasure and things to distract yourself, it's 1 million to 1 ratio, where mind over matter is even worse. It can't happen, and it doesn't happen. Talk therapy, for instance, reinforces the problem. There are ways of training your brain to feel safe. I'm all over psychology, but there's a new field coming out called somatic psychology that helps people feel safe. If you feel safe, your body chemistry comes back into action. There are two parts to healing. One is to learn how to process anger and anxiety or activated threat response. It's a dynamic process. It occurs every day. That's over there protecting you. It's a gift.
In your conscious brain, where the healing occurs is you move your brain into what you want to do, then you start stimulating neuroplasticity. That's where people heal. You can't heal unless you negate these circuits. Negating the circuits doesn't cause healing. You have to get your brain onto the solution, not focus on the problem. It's like learning a new language.
You're not going to learn French by trying to fix your English. The default language in humans is a survival stress reaction. The language that you want is what I call an enjoyable life. I have a little saying, "To have an enjoyable life, you have to live and enjoy life." You have to practice. Their life skills are separate. Processing stress is one skill. Learning joy is another skill. They're linked, but you can't use pleasure to counteract the negative forces.
That's fantastic. I wish that this was more widely used with teenagers.
We're working with kids more often. There's one example of somebody I'm working with now. I won't tell you her name, her age even. She's young. She's successful in her business. She had gotten crippled with anxiety, flat out on her tail with it. You say, "How long does it take to work?" She's already within two weeks. All of a sudden, she has hope. We know having hope has been documented in research to be anti-inflammatory. When I tell all about these big diseases, chronic pain is one of those because what happens when you're inflamed is that the speed of your nerve doubles. Your brain becomes inflamed.
Having hope has calmed her down dramatically in two weeks. A lot of people, I say 3 or 6 minutes on average, is a learned skillset. I talk about you becoming a professional at learning to live your life. Most of our skills are survival skills. We are not taught how to process anxiety and anger. We certainly are not taught how to nurture joy. Everything we do is this survival reaction. It's a learned skill set. Talk about becoming a professional and living your life. As you become more competent in living your life, you simply spend less time in fight or flight.
How can people learn more about this? How can they get started? Is there a way to tiptoe into this and make sure it feels like a good fit? How do people find you and learn more?
I put a process together called Direct your Own Care Journey. You can't go from anxiety to happiness in one step. That's not going to happen. There are seven legs to it. In the first leg, we tell you some simple tools to get started, to start calming your nervous system right away. One of them, as you well know, is called expressive writing. You're going to write down your thoughts and turn them up instantly. You can't control your thoughts, but you can separate from them. That's always the starting point. The second thing is to learn about the problem. You can't solve your problem unless you understand it.
The third thing is called active meditation. You put your mind on a different sensation for a few seconds and do that all day long. The fourth thing is sleep. It's a big one. If you're not sleeping, none of this works. It's all linked. The final one on that first layer is interesting because it's concrete and simple to do. We talked about it in our coaching room. It's to never discuss your pain. It wears your attention. If I'm here in my office, you'll see me walk out of this door. You'll never discuss your pain ever again with anybody, especially your family. Friends, family, or colleagues, you're going to stop discussing your medical care. No complaining. Don't give any advice. No criticism. No gossip. All that stuff fires your nervous system.
If you don’t learn about the problem, you can't solve it.
If you're constantly complaining from a neuroplasticity standpoint, that's where your brain developed. This is not psychological. You're changing the physiological structure of your brain. People have a hard time. Here's what I did find out myself personally. I did this myself for fifteen years. Patients with chronic pain, including mental, talk about their troubles all the time. Probably 60% of their waking hours are spent thinking about their pain and trying to solve their pain. They focus on the problem, not the solution. It's an easy concrete step. You walk out of my office today, done.
That's good. It's things that I've heard before in terms of starting your day with gratitude and making sure that you're constantly staying in positive words, positive voice, encouraging, and supporting.
The other thing I want to tell the readers is critical. This is not about David Hanscom. I don't have some magic formula. I'm just bringing the proven neuroscience into the real world. Somehow medicine is all we're looking at completely. These are proven medical treatments. My contribution is to arrange them in a way that people can access them. The healing process starts with your skepticism because you have to connect with what is. What doesn't work is positive thinking because you've covered up negative thinking. People think, "If I generate enough belief in David Hanscom or in the DOC Journey, I'm going to heal." It's the opposite.
You want to connect with your healing capacity of being able to connect with yourself, which includes negativity. I encourage people, "Don't believe me. Suspend your disbelief enough to engage and watch." Hundreds of patients have gone through this. The other resource we have is called the DOC Journey app, which is interactive, entertaining, and enjoyable but also educational.
I did write the book, Back in Control: A Surgeon's Roadmap Out of Chronic Pain. I picked it up, read parts of my book, and go, "This isn't bad." It doesn't reflect the latest neuroscience, but it's a great foundation for what the problem is. The problem is if people are trapped in anger when they are in chronic pain, their brain goes from the thinking centers to the survival centers. The problem blocks treatment.
You can't think clearly. One of the biggest problems we have is that people don't want to give up their pain because they can't hear me. That's one of our challenges. People that are willing to engage and stick with it. You're not going to learn how to play golf by reading a golf book. You're not going to learn how to play the piano by looking at the piano and reading a book. These are skills you practice to become a professional and live your skills. Practice your life skills. You become confident at everything, processing stress, living your life, and doing what you want to do. Your brain changes. Your people do heal. They drop out of their pain completely.
I had one patient who is in 55 years of chronic pain. She has been fine for a few years now. There's another gentleman who had 28 surgeries in 20 years. He has never felt better in his life. Personally, I was in chronic pain for fifteen years. I'd given up completely. What's fun about this process is we don't have to fight the pain of our brains anymore. People thrive at a level they never knew was possible. Quitting my practice was a big deal.
That was not a small step. When people heal completely, it's incredibly inspiring. Plus, it's hard for me to watch people being badly damaged by medicine now. It's been an incredibly rewarding project. That's why I have so much passion behind it. You can hear me on my podcast. You have the same passion. You watched some serious healing take place. You see it happen all the time. It's pretty inspiring.
Yes, especially you can combine the worlds of reducing inflammation from what you put in your body and also how you're thinking about the situation around you in your life. It's super powerful.
It's powerful and consistent. It's not hard. As a surgeon, we were focused on the structure where 98% of your symptoms are based on physiology. Things like mindfulness meditation, exercise, and sleep, all these things you're doing are anti-inflammatory. We know that if you are eating a high sugar diet, that inflames the heck out of everything. Surgeons are going to be the worst people on this planet for diet. One example, one of my fellows sat down for lunch with me one day. I don't eat well, but he sat down with 3 bags of popcorn and 2 Pepsis.
Maybe he holds a record for a bad diet. Surgeons don't eat well because we are busy all the time. When you're constantly eating processed foods, it inflames the heck out of your liver. What happens is the fat goes to your abdomen. That core abdominal fat is like a little furnish thrown off in inflammatory cytokines. An anti-inflammatory diet is critical. Let me say one more thing. Solving chronic pain is complex. Everybody has a different set of circumstances. One interaction on his own never works. An anti-inflammatory diet is not going to work. Can you add it to the other things you're doing? Yes, if you're doing better sleep, exercising, and your diet is good. That additive effect of all those interventions is what causes the body to heal.
If you're eating a horrible diet and not sleeping, nothing else matters. It's a combination of this individual. The bottom line is the person has to take control of his or her care because who else is going to solve a problem? It's not your doctor. If I am going to spend eight hours a day with you, talk to you, and listen to you, you're not going to get better. You're going to get worse. The key issue here is a patient takes control. It's not hard to do. The patients that are healed have pointed out this is disturbingly simple. I'm not that happy that I lost fifteen years of my life. I did fifteen years in chronic pain. It's been a long time. I'm not that happy about it, especially when I know it was preventable and could have been cut a lot shorter than it was.
I was excited for me to at least give it back. That's how I learned. It was my hard way. I don't want to throw my colleagues under the bus because I was one of those guys. I did surgeries. I had no idea about inflammation. I didn't respect the body's physiology. We're going to short train that way. Anyway, it's become, by far and away, the most rewarding phase of my career.
How do people find out more about you and how to work through the DOC Journey?
My book is Back in Control. My website is BackInControl.com. On that website, you can see a link to the DOC Journey course. You'll see a link to the DOC Journey app. Probably the easiest is to get onto the BackInControl.com website and then take it from there. With The DOC Journey course, I recommend 15 to 20 minutes a day at the most. If you read a whole piano book, you're not going to learn the piano. People jump through the course quickly, then they get frustrated.
This is 15 to 20 minutes a day, day after day. Repetition is key to retraining your brain. The app is the same thing. It's audible. It's interesting and entertaining. As part of The DOC Journey course, I offer group coaching sessions twice a week on Tuesdays and Thursdays. It's about 25 to 35 people per session. We have a great time. Community and structure help calm down the nervous system also.
Thank you so much, doctor. I appreciate your time.
Thank you.
Important Links
- Back in Control: A Surgeon's Roadmap Out of Chronic Pain
- Do You Really Need Spine Surgery?
- The DOC Journey
- DOC Journey - Apple Store
- BackInControl.com
- Group Coaching Session
About David Hanscom
David Hanscom, MD practiced complex orthopedic spine surgery for 32 years. He quit his practice in Seattle, WA to present his insights into solving chronic pain, which evolved from with his own 15-year battle with it. He eventually escaped from the ordeal and discovered that mental pain is the biggest issue. Anxiety is the pain.
His book, Back in Control: A Surgeon’s Roadmap Out of Chronic Pain systematically presents established treatments for chronic mental and physical pain, which the current medical establishment is overlooking. The self-directed action plan is available at www.thedocjourney.com. It reflects the approaches of hundreds of patients who have escaped from chronic pain.
He recently launched a movement called, “Dynamic Healing” that recognizes the interaction between stress and one’s coping capacity. An overwhelmed person subjected to sustained levels of flight or fight hormones will develop unpleasant symptoms and serious illnesses.