If you suffer from chronic pain, it becomes all you think about. The pain gets to the point where it consumes your days and almost every activity is dictated by how much pain you’re in. Thankfully, there are ways to manage it so that your pain doesn’t rule your life. The Cheat Sheet spoke with Dr. David Hanscom, an orthopedic spine surgeon and author of the book Back in Control, for more information on how to manage chronic pain. Here’s what Hanscom had to say.
The Cheat Sheet: What classifies pain as chronic?
David Hanscom: Historically, it has been defined as pain that lasts longer than would be expected for usual tissue healing. Based on new research, using functional MRIs, we are finding out that chronic pain is a complex neurological issue. A functional MRI is a test where a labeled glucose is injected into a vein and will travel to the most metabolically actively areas of the brain. It is becoming increasingly sophisticated and can measure very small changes. One of the most active groups out of Chicago wrote a recent review article and here is one of their summary statements:
“We redefine chronic pain as pain that does not extinguish its memory trace … implying that supraspinal/cortical manipulations may be a more fruitful venue for adequately modulating suffering and related behavior for chronic pain.”
In other words, pain becomes associated with other neurological circuits over time and complex cross-wiring happens. Once these connections are established, they are permanent. They are solvable with specific tools but right now medicine, as a whole, is not using these strategies.
CS: What inspired you to write Back in Control?
DH: I suffered from chronic pain for 15 years, from 1988 to 2003. Pain creates stress in addition to other life stresses. The body secretes stress hormones that include adrenaline and cortisol. A sustained level of these chemicals causes every organ system to respond in its own unique manner. There are over 30 physical symptoms that occur from an amped up nervous system. I had 16 of them at the same time and was in bad shape. I was lucky to come out of this hole and it took me a few years to figure out the tools that worked and why. The concepts in the book arose from this experience and it is incredibly rewarding to teach these concepts to people and witness their healing. With engagement, it usually occurs within three to six months and happens most of the time.
CS: What should be the first step in addressing chronic pain?
DH: I have evolved an outline of the sequence from observing what has been effective with me and my patients and what has not. Here is an overview of these phases:
Build a foundation
- Learn about the chronic pain and all of the factors that influence it.
- Get adequate sleep. This usually requires meds the first two to three months.
- Begin negative writing. Research has shown that simply writing down your negative thoughts and destroying them somehow breaks up these irrational pain circuits. Mental and physical pain are considered the same entity.
- Combine the writing with “active meditation” which means you learn to place your attention on sensations, such as taste, sound, smell, feel, etc. When your attention is on sensations it is not on the pain pathways.
- Forgiveness — it is a necessary step to calm the nervous system and move forward.
- Start physical exercise.
- Practice gratitude.
- Start adjusting meds down.
Take back your life
- Goal setting: Re-create a vision for the life you would like.
- Family issues: Understand the affect that chronic pain has on the family and your family.
- Give to those who are in worse shape than you.
- Re-engage with friends and family. When your brain is connected to your life is less connected to pain.
- Regain your perspective of being human. Put your issues in perspective.
- Play: Pain pathways are permanent but so are play pathways.
CS: What role does the nervous system play when it comes to pain?
DH: It has been shown in recent functional MRI scan research that LBP switches from the pain center in the brain to the emotional center, which means that the pain is the same but the emotions of anxiety and anger are the drivers, not the pain center. It is similar to having your hand trapped over a hot stove burner. Your anxiety goes up and then anger, as you are trapped. Your body is now full of stress chemicals that amplify the pain signal. It is a vicious loop. Additionally, your brain memorizes the pathways, similar to an athlete and they are permanent. You have to both calm down the nervous system and create new pathways to solve the problem. Fortunately, they are simple.
Stay tuned for part two of our chat.