Chronic pain can become an all-consuming force in your daily life. After months or years of suffering, it can be a thorn in your side that forces you to plan each movement and activity according to your pain level. However, you can take back your life and regain control. There are some methods that can help you manage your ailment so that you can get on with your life. The Cheat Sheet spoke with Dr. David Hanscom, an orthopedic spine surgeon and author of Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain, for more information on how to manage chronic pain. Here’s part two of our chat. (You can view part one here.)
The Cheat Sheet: How do you calm the nervous system so that you can rid yourself of pain?
David Hanscom: There are many methods, centered mostly around mindfulness and meditation. I start with the “active meditation” as described earlier. The negative writing is critical. There are over 150 research papers since 1982 that document its effectiveness. Sleep is number one. Without sleep it is impossible to calm down and proceed with the rest of the process. Medications are often needed for the initial phases.
CS: Do you think alternative medicine (for example, acupuncture) has a role in the management of chronic pan?
DH: There are three steps to “reprogramming” your nervous system. First, become aware of what your current automatic response is to stress and pain. It is a survival response. Second, create space between you and the stressor. Third, reprogram your brain; where you put your attention is where your brain will develop. Chiropractic care, massage, and acupuncture fall under this reprogramming step and are very helpful. Remember that there is never an answer for chronic pain. It is a combination of tools and these can add to one’s healing. It has also been demonstrated in the literature that “alternative medicine” is more effective than traditional medicine in treating chronic pain.
CS: What is the psychological effect of chronic pain? What should a patient do if he is at a point where he is self-soothing with drugs and alcohol in order to escape the pain?
DH: I think the driving force behind chronic pain is anxiety. It is universal, powerful, and drives essentially all human behavior. Just as pain is a physical link to the environment, anxiety is the mental link that is necessary for survival. It is irrational and is a neurological issue, not psychological. Addressing the masking behavior will not solve the root problem of relentless anxiety, which is absolutely intolerable.
One of the problems is that anxiety and anger are the same entity. Anger results when you lose control of a situation that is creating anxiety. Anger is the body’s survival response to really solve the problem with extra adrenaline. Anger is only about you and survival and is destructive in its nature. It is also self-destructive, including these masking behaviors. One strategy is to recognize that you are this mode and develop alternative “destructive” behaviors that do not have as severe a consequence. One problem I see frequently is a patient on heroin who develops an infection of their spine. The consequences are severe. Is there an alternative behavior that can be developed that does not have these extreme consequences?
CS: At what point should you consider surgery?
DH: I am a busy surgeon who corrects problems such as tumors, fractures, scoliosis, kyphosis, and infections. I also salvage other surgeries that have not gone well. These interventions are usually helpful, although the circumstances leading up to the problem are not as solvable. The only time I will perform surgery for degenerative conditions is when I can identify the exact anatomic problem creating a corresponding pain that is severe enough to warrant the risks of surgical intervention. The success is well over 85%. If I cannot identify the exact problem I never perform surgery.
CS: Any final thoughts?
DH: Regardless of the source of your pain, whether it is structural, non-structural, or neurological, it is a solvable problem for the vast majority of people. The tools are simple and only require an open mind, engagement, and practice. I have given a lecture titled, “Enjoying the Management of Chronic Pain” and it is the most rewarding aspect of my practice. I am grateful that I am able to pass along the insights that I learned from my own journey out of chronic pain.
Read part one of our discussion here.