Reset your brain and body for a pain-free life.

Joe Tatta, PT, DPT


Non-Surgical Spine Care With Dr. David Hanscom, MD

Welcome back to the Healing Pain Podcast with Dr. David Hanscom, MD.

This week, we are talking about a surgeon’s road map out of pain. When we think about pain, we think about chronic pain. If I asked you, have you ever had lower back pain in your life? Have you ever had neck pain? Have you ever had pain that maybe was in your right buttock or your left buttock, or maybe went down the back of your leg or to your calf? Chances are most of you would say yes to that. My guest this week is Dr. David Hanscom. He is a orthopedic spinal surgeon who wrote a wonderful book called Back in Control. It’s really a great book about integrative strategies for healing chronic pain.

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Non-Surgical Spine Care With Dr. David Hanscom, MD

I’m happy to have Dr. David Hanscom on the show today and I want to welcome him.

Thanks, very happy to be here.

I really would like to start maybe just with a little bit of your story. When the average practitioner or patient thinks of a spinal surgeon they think that primarily what they do is spinal surgery, and there is obviously a need for that and it does have its place in our healthcare society. Although we’re seeing many of the surgeries may or may not be necessary depending on what type of condition you have and what type of pain you have. What’s your journey into this wonderful approach you have to treating those with chronic pain?

HPP 039 | Non-Surgical Spine Care

Non-Surgical Spine Care: I started sharing things with patients and people started getting better, including myself.

I trained in a place called Minneapolis, Minnesota, which is considered one of the top Spinal Deformity Fellowships in the world at the time. I came out of the fellowship on fire with the zeal to do surgery pretty much in everybody. I spent eight years being a very aggressive surgeon. I studied a lot of complex spine surgery, but I noticed that my back pain surgeries weren’t working very well. The surgeries were successful as far as gaining a fusion. The data came out 1993 in the state of Washington that the success rate for a spine fusion for back pain in the workers population was 20%. I just stopped. I go, “I was getting about 40% success rate, which wasn’t great.” I thought before the data came out, the success rate was around 90% – 95%, and it just wasn’t. Then, I went into a chronic pain mode myself about the same time, for about fifteen years. I developed severe chronic pain for a very long time. I got very lucky coming out of it. That was about 2003 and it took me a few years, I forgot what happened. I didn’t know how I got into it. I didn’t know how I came out of it. Around 2006, I started sharing things with patients and people started getting better, including myself. I’ve been relatively pain-free for about thirteen years. As my wife aptly points out, I quit practicing the tools my patients were supposed to do, my symptoms come back in about two or three weeks.

In 2011, I heard a lecture by Dr. Howard Schubiner out of Detroit on chronic pain. That’s when this whole thing came together for me and I go, “Wait a second. This is what happened.” Dr. Schubiner listed 33 symptoms of an adrenalized nervous system. I had sixteen of them at the same time and all of them are gone. It’s been a remarkable journey for me. I’ve been incredibly honored, fortunate, to share these tools with my patients. We’ve watched hundreds of patients go to pain-free.

It’s wonderful when someone has pain themselves, especially when you’re a practitioner, because you can really understand what someone is feeling, what they’re going through, their struggles, their frustrations, their anxiety, and of course their trials and tribulations with negotiating our healthcare system to try to find relief. Dr. Schubiner has been a on my podcast. He has a wonderful book called Unlearn Your Pain, and a wonderful way to help people solve their chronic pain. Can you give us some stats, just some really basic stats about the incidence of back pain and spinal pain in our society?

The numbers are a little all over the map; a common number is 110 million people with chronic pain. It depends how you define it. Probably severe chronic pain is probably closer to 25 million, which is plenty. If you look at my new , the neuroscience research is showing that anxiety is the pain. Anxiety is not a psychological issue. Anxiety is simply a chemical reaction to sensory input. If you look at anxiety being the pain, essentially everybody has chronic pain because everybody has anxiety. It depends on how you define it.

You started to bring in aspects of the nervous system, which I wanted to get back to. I talk about it all the time in my podcast and on my blogs and things like that. As a physical therapist, sometimes people do come to me directly first. One of the questions they have about their pain, especially spinal pain, is should I go for an X-ray or should I go for an MRI? Can you explain to us, is that necessary for those who have chronic back pain? Who really should go for imaging studies and why is that important?

There have been criteria for decades about the red flags for back pain. Back pain is only a symptom. It can come from ligaments, , ruptured discs, all sorts of stuff. It also could come from trauma, fractures, tumors and stuff like that. Certain symptoms that causes to do imaging early, and most back pain is benign. It’s really hard to make that rule in generality because I think it’s a little risky to do that. For a person who walks in my office with I think should be a tumor, it’s usually a tumor. I’ve done it for 30 years so I know that. I’ve watched people come in with three to four weeks of back pain that I never image, X-ray or MRI scan. I’ll treat them for two to four weeks. As the pain goes away, there’s nothing to do. The problem I’m seeing right now, people get MRI scans very quickly. Everybody has degeneration at some level at about age 40. After age 65, it’s 100%. There’s a lot of things that we don’t know about back pain. We actually do know that disc degeneration does not cause back pain, as you well know. It’s ironic because that data is well-proven, multiple papers, there’s over 300,000 surgeries done a year on degenerative disc. There’s a complete disconnect there. It’s a bit of a problem.

It’s a wonderful point that the degeneration that we see on imaging studies is poorly correlated with one’s pain. Is that correct?

Absolutely. In fact, there’s essentially no correlation.

My curiosity as a clinician is how do your peers start to process some of that information? We still have what’s called a biomedical model in our healthcare system where people are relying on imaging studies. It’s not just physicians; there are other types of practitioners that use imaging studies and now some physical therapists even have the right to image in certain states. How do we encourage people to look less toward that and more toward the other factors?

I’m not totally sure. I think the imaging juggernaut has gone really more aggressive in the last five years, inappropriately so. It was not great 30 years ago when I started, but we’re doing more aggressive imaging, more aggressive survey. I used to say maybe 50% of spine tradition had never been done, I now think it’s up over 70%. The problem is it’s not just spine surgery. It’s cardiology, it’s urology, it’s psychiatry doing medications. What’s happened is we’ve taken the body’s physiology, which creates physical symptoms, and we’ve defined the structural problems, but if you’re treating a physiological problem with a structural approach, it can’t work, and it doesn’t. It’s tricky.

The average practitioner really should keep in mind those red flags first because there are red flags for back pain, you mentioned one, which can lead to cancer or tumor. There are other things like an acute fracture and history of cancer. Those things should be in the forefront as clinicians that we think about first. That really should be the precipitous to imaging studies. However, most of the pain we’re seeing are not those red flags, is that correct?

Right, probably 99%.

You started mentioning the nervous system. In your book, you talk about a concept called sensual sensitization, which is a difficult concept even for clinicians to grasp. Can you explain what that is to the average person?

HPP 039 | Non-Surgical Spine Care

Non-Surgical Spine Care: Your nervous system takes all the central input and guides your behavior unconsciously to keep you safe.

I’m going to be a little cynical here. I think this is high school physiology. We went to medical school, you went to physical therapy school, and you know this, that when your body is under stress, you have a chemical reaction called adrenaline and cortisol. The way humans survive, in fact, every living creature survives on this planet, as your nervous system processes sensory input: taste, sound, smell, touch. You process the input and then you behave in a way that keeps you safe. Every physical sensation plus they’re all coming at the same time. Your nervous system is taking all the central input and is guiding your behavior unconsciously in a way to keep you safe. For instance, I’m sitting here unconsciously shifting in my chair so my skin doesn’t break down. I’m not thinking about that. My brain is doing that for me. As you well know in physical therapy, if you lose sensation, your skin breaks down. If you have pleasant sensations, nice music, warm beach, your body secretes dopamine and oxytocin, then you feel relaxed. When you feel relaxed, you just feel that chemical surge. If you have bright lights, loud sounds that startle you, then your body signals danger and sends adrenaline and cortisol, then you feel anxious. The anxiety feeling is just a chemical reaction that is not psychological.

Humans have the additional problem, the research is now showing, that thoughts do the same thing. Pleasant thoughts give you reward chemicals and relaxation. Unpleasant thoughts give you adrenaline and cortisol, then you feel anxious. The problem that humans have is that you cannot escape your thoughts, so you’re trapped. You can suffer your thoughts, suppress them or try to mask them. None of those work. It appears and it’s becoming more and more apparent that probably the basis of chronic pain in humans is this progression of thought throughout the lifetime. You have a back pain injury at twenty years old, no big deal. But at age 40, being trapped by your thoughts over a lifetime, that part of your brain’s already lit up. The thoughts create the same neurological reaction in the brain as physical sensations do, and then the same chemical reaction which you can’t escape from.

You have this relentless aggression of thought that create this relentless anxiety. If you treat anxiety as a psychological issue, you can’t do it because the unconscious brain is one million times stronger than the conscious brain. One of my personal symptoms was extreme anxiety in a form of an Obsessive-Compulsive Disorder, which is a disaster. It’s a problem. I treated it psychologically. What I found out is I talked about this circuits that actually reinforced them. It became stronger and stronger, and stronger. I have been free of OCD for at least twelve – thirteen years. The psychological prognosis for OCD is dismal. You’re trying to treat something that’s not treatable. Once you actually let it go or separate and turn another direction, the change is remarkably fast. I have friends and family and some patients with OCD that once you understand the model, within weeks things start to change around. It’s a remarkable shift.

You talk about this in your book. You talk about feeding repetitive thoughts. You mentioned this framework, because I think it’s brilliant; suffering, suppressing and masking. Can you talk about that a little bit more so people understand what that framework really means and why it’s important when they’re trying to heal their pain?

Let’s talk about thoughts being the pain for a second. As you get older, just like an athlete learning a skill, as you experience these repetitive thoughts over time, it becomes stronger and more embedded. It becomes like a freeway compared to a small road in other areas of your life, so it becomes stronger and stronger. It starts pushing out creativity in interaction with other people. People in chronic pain can become very socially isolated. They spend more time thinking about the negatives. It becomes a huge cycle that embeds itself. It’s been documented in research what we already know. If we try not to think about something, you think about it more. The research out of Harvard shows you think about it a lot more. There’s a big trampoline effect.

Suppressing is a disaster. It’s actually been shown that suppressing damages the brain. When you suppress thoughts or emotion, it damages the hippocampus of the brain, which is a short-term and long-term memory center. There’s also a link between thought suppression and opioid abuse. It turns out thought suppression is a huge, huge problem. The solution, by the way, is actually learning to live with uncomfortable thoughts, then they start losing their power.

The third thing we all know, masking, works a little bit. I’m a workaholic. I did that for a while. Different addictions, drugs, whatever you want to do, busyness over exercise, all those things masks to a certain degree. It actually works for a while until it doesn’t. I was remarkably successful in masking for about twenty years. My first symptom of this whole thing breaking was panic attacks. I went from having no anxiety to panic attacks, and then going, “What’s this? I have no idea.” I always do that. When you suffer, suppress or mask, you can’t solve the problem, so what do you do? Plus, it’s the unconscious brain, so it’s a million times stronger than the conscious brain. There is a solution, but it’s not by consciously addressing the unconscious brain. It’s like taking down Mount Everest with a pickaxe. You can’t do it.

You mentioned in the description, if you can’t get away from your pain, then in some ways you have to learn how to be present with it. That’s the basis of mindfulness-based stress reduction, is being present with unpleasant feelings, really. How much of that arena do you speak with your patients about today?

A lot. First, I want to be really clear. The patient that I talk about go to pain-free. It’s not like managing pain, the pain really does disappear. What happens is like diverting a river into a different channel. The approaches are decreasing the adrenaline, which mindfulness does that. When you have an adrenalized nervous system, the animal studies show that the conduction of the nerves goes by 30% to 40%, so you actually feel more pain. As you decrease adrenaline, that makes a difference. You can create new pathways around the old pathways, create detours. You can do that by connecting thoughts with physical sensations, which is a schematic work, which feeds into what you do as a physical therapist. The third thing which is the most powerful, which has been fascinating to me, is that you can shift from pain pathways into prior non-pain pathways. For instance, pain pathways are permanent. Play pathways are also permanent, although they get buried under life in general.

We do a seminar in New York, at the Omega Institute. We’ve done it for three years. In that week, essentially 80% of people went to pain-free. What happens is they started to relax and share and laugh. My wife is a tap dancer. As we started doing these crazy rhythms together, and it was crazy, we found this inadvertently, that as she taught these little hand rhythms, and we fumbled around and did what we did, we just started to laugh. Within 24 hours after people started to truly laugh, pain disappeared. We went back to their triggers at home, of course, the pain came back. It becomes a learned skill that you’ll always be triggered. When you say pain-free, you realize you’re triggered, the pain comes back, then you move forward.

We’ve learned that also,= people in chronic pain talk about their pain a lot. They tend to complain about it, talk about it, discuss it. One of the rules that we made was you cannot discuss your pain, because you’re simply reinforcing the circuits. Going back to the question of suffering, suppressing or masking, there’s actually a research called unpleasant repetitive thoughts. The whole line of research development around these thoughts is that you can’t escape the thoughts, you can’t solve them, you can’t control them, but you can separate from them.

HPP 039 | Non-Surgical Spine Care

Non-Surgical Spine Care: Chronic pain is a curable problem, but you have to separate then you redirect.

What happens if you’re using mindfulness alone to go back to the unconscious part of the brain, it does decrease adrenaline. It’s one of the more effective tools. But by itself, it can’t work as far as curing chronic pain. Chronic pain is a curable problem, but you have to separate then you redirect. There’s an exercise I think I wrote about a lot in the book called expressive writing. There’s over 300 research papers since 1982. It started in Austin, Texas, which was simply writing down your thoughts and destroy them, start separating from the thoughts. Because the thoughts are here. You’re here. There’s a space between a piece of paper and you. That space is connected with vision and feel, which is part of the unconscious part of the brain.

The reason why my patients tear these thoughts up is because, first when I write with freedom, whatever it is, positive or negative, rational, irrational. The thing is you don’t want to analyze them. Where’s your attention? On the thoughts. When you analyze them, it’s a big problem. You must not put your hand right into a hornets’ nest. To be honest with you, I’m an advocate of psychotherapy. I was an advocate of psychotherapy for thirteen solid years. Things just got worse. I didn’t understand the model, obviously. It really got bad. What happened to me inadvertently is I picked up a book that said to start to write, so I started to write. For the first time in fifteen years, things started to shift. Six months later, I’ve gone through another series of steps, including forgiveness, that pain disappeared. What happened in retrospect, I started to decrease adrenaline, but I started to feel safe. When you’re angry and frustrated, you’re simply projecting your view of the world under people and things. The first person you had to feel safe with is yourself. You have these unrelenting thoughts that seem like they’re attacking you. You can’t escape them. You’re trapped. If you are trapped by anything, your body’s full adrenaline, which then increases the nerve connection which increases the pain. Then it turns out again, going back to the further part of the conversation, anxiety is the pain.

So many people, still to this day, look at pain as that sensory experience, and it is, obviously. There are changes in the peripheral nervous system. The pain you’re feeling in your joints, the tension, the tightness, the muscle weakness, that’s all important. There’s also the emotional component because pain is both a sensory and an emotional experience. You started talking about different concepts. You’ve mentioned anxiety a number of times. You just brought anger into the conversation. You brought in forgiveness, which has a lot to do with anger. It’s two separate spectrums. When do you bring these topics into your treatment with patients and how do you do that? I think when someone comes to see you, they know you’re a different type of spine surgeon. They’re expecting something different, so to speak. Where do you start to bring this in? These are not concepts that the average person has come across. If you Google a herniated disc on the Internet, you’re just going to get big pictures of a big red bulbous thing pointing out of the back, pressing on a nerve. We know these are nocebo, which means they cause more fear and anxiety in people. How do you start to bring these in with patients and where do you do that?

The concepts are different. Actually, the research has been really deep for about 50 years. This is mainstream medicine. This is not alternative medicine. If you look at my book, it’s basically based on sleep, basic medicine, stress, basic medicine, physical conditioning, medication management and life outlook. It’s actually a wellness book. It addresses primary care issues in a systematic way. I see a patient for a surgical consult. I say, “Don’t expect to understand this here in the office.” I hand him a copy of my book. I say, “Here’s the website. Go to the website first and start two things. Start the expressive writing and a form of mindfulness called active meditation. Like right now, just feel where you’re sitting, which will bring on some sensation for three to five seconds, that’s it.”

You shifted off pain pathways under a different sensation. The brain really can be consciously aware of one sensation at a time, you’re not connected to the present moment. Instead of fighting the pain, you’re using an abbreviated form of mindfulness simply to switch sensory input. Then, I ask them to get some sleep. What’s been fascinating, which is probably going to be the basis of my next book, which I’m actually starting to research, is the family issues. It’s unbelievable because families are neurologically linked to what’s called mirror neurons. If you’re in a bad mood, it actually stimulates the bad mood neurons in your brain if we’re in the same family.

I have some homework that I’ve started to give people, which has been fascinating. We learned this in Omega. I said, “One of the rules is that you cannot talk about your pain. You can’t complain. End of story.” In terms of that, most couples, or at least the person in pain, talks about the pain all the time. First, it’s your family members. They can’t do much about it. They feel bad for the person in pain. It’s also not that interesting after a while. It just wears the family out. I say, “I want you to visualize a ten-foot wide concrete reinforced wall between you and your spouse as far as pain. When you walk out the door of my office, you cannot discuss your pain ever again. You also cannot complain ever again.”

I ask both spouses to fully engage. I said to the other spouse, “If you don’t have pain, anxiety or stress,” which obviously everybody has, “If you had a bad day at work, you can’t bring that home either. Your homework on the way home from my office is you talk about the most enjoyable part of your relationship and just talk about it. Reminisce, thoughts, feeling, vision, dreams, whatever you had, and just spend some time with that and wake up that part of your brain. When you walk in the door of your house, that house now becomes your haven. You take the energy into the house. If you get triggered and want to argue or fight, take it outside. Get in the car, walk around the block, whatever you want to do; do not fight in your house ever.”

HPP 039 | Non-Surgical Spine Care

Non-Surgical Spine Care: I’ve got about ten rules of engagement on the website about family issues. Anger is so powerful.

I’ve got about ten rules of engagement on the website about family issues. The problem is that anger is so powerful in causing to attract more than anything, including pain. While you become very frustrated, very adrenalized, you don’t think very clearly. What I noticed when I get in arguments is the same script. You can script the argument almost word for word. All you do when you argue is you simply bludgeon each other. You’re not going to solve anything. Instead I’m making a rule that if you decide to get angry, the other person gets permission to leave, just disengage. My wife and I are a work in progress. We’re getting better at it. It’s about triggers. You can’t control most of the world, but you do have a lot to say about your household. It turns out that the family, if you try to heal from chronic pain, and you go home and get triggered, everything fires up. Conversely, if you create a safe haven with your spouse, with your family, with your household, then it’s the opposite process. It’s a very powerful way of coming out of the hole.

I’m very excited about this rendition of the process because it’s a little bit unexpected. I know a little bit about the family issues. It turns out it’s a very powerful force for bringing people down. I can tell you, when I tell people there’s a ten-foot wall between you, I’m talking about your pain, the biggest smile breaks out on the other person’s face, on the spouse’s face. Because they’re tired. They’re worn out of hearing about this person’s pain. It’s been an exciting phase of the process. I think maybe one of the bigger factors, as far as potential healing, is the family.

We know that support, whether it’s a support group or a support from a friend or even the therapeutic alliance between the practitioner and the patient is oftentimes the most important part of the healing experience. Obviously, if you’re at work, there’s only so many things you can have control over at work. You may not be able to control your coworker, but when you get home, hopefully, you have a little bit more influence. Obviously, the person who loves you, who’s living with you, would want to help you along in that journey. It also makes me think of oftentimes people say, “I have pain because my dad had a bad back, because my grandfather had a bad back. It runs in my family.” I wonder if you can talk to that? Because it brings up the whole point of genetics or epigenetics, which are important. My personal opinion on research is that it’s more of an epigenetic experience around someone’s thoughts, memories and emotions.

Epigenetics is that we know the genetic code can change from generation to generation, and that gets passed on to the next generation. I went to a process called the Hoffman Process in Napa Valley, which is a seven-day process, includes awareness of family patterns that get embedded in your brain that play out in your new family. By definition, you always get attracted to your darkest patterns. It doesn’t matter who you’re attracted to. It’s going to play out in your own new family. Until you’re aware of the family patterns that are passed on to you that are now playing out, they’re all reacting to unconscious patterns, you have no chance. You create an organized awareness of patterns. Once you create that awareness, you find out who you are and go with the issue. I want to back up. This is a really critical part of the conversation. When talking about a support group, there’s actually a negative prognostic factor of belonging to a pain support group. The problem is people tend to go to support groups that support each other’s pain.

Depending on how they’re run and what’s allowed, so to speak, in the support group. That’s correct.

I flip this around now and we found that somewhat by accident in Omega, when people weren’t allowed to talk about their pain, it threw them off. Some even ask, “What do I talk about?” I go, “Read a book. Read the newspaper. Talk whatever you want, but pain is not that interesting.” We talk about support. I actually challenge a person in pain to support their family, and then they’ll get the support back. What I found out in a disturbing way that you love your family, but they tend to become the targets of your frustration. Then the patient in pain is demanding support from the family. There’s a research paper I wrote about a couple of weeks ago called The Chronic Pain Marriage-Go-Round. A lot of times the spouses don’t believe the person’s in pain. Then the person in pain grabs her back, makes some sounds, then they get a hostile response from their spouse. They’ve done this little monitoring story that shows that now the pain goes up in the person in pain because of the spouse’s hostile response.

On learning clearly that people in chronic pain’s household are pretty dark, a lot of negativity going on, a lot of deep reactions, a lot of frustration going on. It’s not that the family doesn’t want to support them and vice versa, but again these are unconscious patterns. They’re very, very strong. They wipe out the love that’s in the family. It’s there but it gets wiped out, but it’s actually a neurological trick. It’s about this mirror neurons thing. That’s why these arbitrary roles, simply not talking about the pain, not complaining. You can bring that positive energy into the household, have the same dramatic effect. The support is, what can I bring into the family that’s positive today? What can I do to not bring in the negativity? As you know, I’m not into positive thinking. I was thinking into a way that’s suppressing negative thinking, so that actually makes things worse. Nobody is asking you to be happy about being in pain. That’s not the goal. I call it connected and engaged thinking. You can do the right exercises, take it on a piece of paper. People will say, “Who do I talk to?” I go, “That’s what the piece of paper is for. Just get it out on the paper.”

When you make a commitment to honor your family and support them and go back to the energy you had when you were dating, things start to change. It wakes up that part of the brain. It’s about, where do I place your attention? You can’t control the unconscious brain but you can guide it. It’s like you’re directing a river into a different channel. If you start putting your attention on good food, good wine, good friends, good times, that’s where your brain starts to go. You know you can’t get rid of these pain circuits because they’re permanent. It’s like riding a bicycle. As you use them less, they atrophy. In some tipping point, that’s when the pain starts to disappear, you switch into a different set of circuits to create nuance around the old ones, reinforce the play pathways, and things start to change dramatically. People would go to pain-free. Then you had that physical conditioning part of it, like the weight-training, strengthening. There’s something about the weight-training physical therapy by the way that is not just therapy. I think there’s a neurological substitution process. If I’m in the weight room working the muscles around my spine, my brain’s getting a different sensory input than just thinking about my pain on my back. The stretching, strengthening massage deep tissue work that you do is phenomenal.

The noun to use for treating chronic pain, by the way, is simply becoming aware of the problem. You treat every aspect at the same time and then the patient takes control. To me, the metaphor is like fighting a forest fire. It takes multiple strategies to fight a forest fire. Everything counts. With chronic pain, there’s never one answer. It’s never just sleep. It’s never just physical therapy. It’s never just mindfulness. Everybody is just totally different. There’s always three to five solutions to solve the problem. It’s a combination of things that actually solves the problem.

I always tell people that pain is like a puzzle. We’re looking for the couple of pieces that are unique to you. We all have our different puzzle. There are a couple of pieces that are unique to you and we get them in the right order, they’re going to snap into place and you’ll be pain-free. I think it’s a really important message. You said a couple of times during this podcast that you can heal from chronic pain. You can live pain-free. We have created this idea of pain management. We have pain management centers. I personally hate the word. I don’t like to use the word because it tells someone that they’re going to have this “job” to do for the rest of their life. It creates more fear and more anxiety versus there must be a way. If we can put a man on the moon, there must be a way to fix someone’s chronic pain.

We have hundreds of patients, by the way, who have become pain-free. My record holder is a woman who’s in 55 years of chronic pain. She’s been pain-free now for about three years. Another girl who I talk about a lot in the website, right there in New York. By the way, if you have a chance to talk to her, she’s delightful. She’d been in severe chronic neck pain for about four years. During the Omega week three years ago, she went to pain-free. For her, it was her writing, sleep, forgiveness was a big one. She was seeing ten doctors, six injections, high dose narcotics, and she just got married last December. She’s pregnant. She hasn’t been in pain for years. That happened within a week. It’s incredibly rewarding to watch these people go to pain-free. It’s been unusual. I had another lady last week, ten years of chronic pain. She went through the process. She could just feel a shift and within days she was fine and she’s been fine. You’re really just connecting with your body’s capacity to heal. It’s all right there. It’s not like a formula. You’re just taking away the interference to connect to who you are. As you connect to who you are, there’s anger being trapped, disconnects you. As you get through those barriers, and you connect with who you are and connect with your healing potential, it’s very consistent.

We’ve been talking with Dr. David Hanscom. He’s the author of a book called Back in Control. I have a copy here. It’s a wonderful, wonderful book. I highly recommend you pick it up and read it. I want to ask him one more question. I think it’s the ever so important aspect of forgiveness. Where does that come into play with someone with chronic pain? Who do they need to forgive? What needs to be forgiven and how do we start to lead them down the road where they can grasp how important forgiveness can be for a part of their healing?

There’s a genealogy of anger. We have a situation that you blame, then you’re a victim and then you’re angry. There’s perceived victimhood when someone hurts your feelings, didn’t invite you to a party, whatever. Then you blame the person, then you’re the victim, then you’re angry. There’s victimhood , like being assaulted, robbed, something horrible thing happened to you or being in pain, by the way, this is legitimate victimhood. Then you manage the situation, the circumstance, then you’re a victim, then you’re angry. The problem is chronic pain and the issue of victimhood is a legitimate reason to be angry. The problem with legitimate anger is it’s harder to let go. At the end of the day, your body is still full of adrenaline.

Dr. Luskin’s a friend of mine who I understand who wrote this book called Forgive for Good. His point is that if you want to hold on to forgiveness, it’s not a religious thing, it’s not a philosophical thing. It’s actually a selfish thing to say, “I can’t control this. I’m going to let it go.” That being said, the research shows that 90% of people that have chronic pain have not forgiven the person or situation that injured them. You have a right to be angry because, who gets to suffer? It’s only you. Life goes on. Forgiveness is somewhat of a selfish act. It’s just saying, “I’m going to live my life today.” If you want to stay angry at somebody that you don’t like, you’ve actually given your life over to that person who you don’t like. It’s very paradoxical. The most powerful thing for you to do for yourself is let that one go. Dr. Luskin wrote a book called Forgive for Good. That book came into my practice about six years ago. You actually cannot heal if you hold on to anger because your body is full of adrenaline. You can’t do it. That’s the dividing line where people actually go to pain-free, is actually if you just let it go, move forward, relax, feel safe. Life goes on.

I talk about forgiveness in my book, Heal Your Pain Now, and oftentimes I think it’s probably the most important aspect of someone who’s had chronic pain because they’ve been through so many different things. Whether it’s seeing practitioners that hasn’t worked, trying things on their own, having people turn them away or losing their relationships directly or indirectly. It’s a really important aspect of healing from chronic pain.

I’m very excited by your perspective. Everything is attached to their specialty. Here you’re a physical therapist, patients come to your physical therapy, so as a physical therapist, you’re determined to get them better. There’s an identity attached to that. Of course you do physical therapy, which is critical. But if somebody’s holding on to their anger, it’s not going to work. You have to do physical therapy. You have to do the forgiveness. You have to work on the sleep. They all count. I’m very excited about your approach.

Thank you. I learned probably within a year of practicing that the physical part is of course very necessary. The research obviously backs it up too. You have to move in some way to heal from pain. There’s an aspect of movement that is very healing. But I had a patient who is very angry about the birth of a child she had at a later point in life. She didn’t want a child. She went through In Vitro Fertilization for it. Her husband wanted it. In conversation, this came up, and her and I talked about it as we were doing all the rest of the things that we were doing. A couple of weeks later, she came in and said, “I think a lot of this has to do with the anger I have been holding on toward my husband.” Within a couple of weeks later, she said, “I think just talking about this has made my pain go away.” It’s what called psychologically-informed care. Physical therapists or a chiropractor or a primary care physician, you can implement some of that into your practice. I think physical therapists have a really interesting place here because they spend more time with the average patient than probably most practitioners, except a psychologist. It has its place.

HPP 039 | Non-Surgical Spine Care

Back in Control: A Surgeon’s Roadmap Out of Chronic Pain

Again, I don’t want to be too negative in psychology, but remember, when you’re talking, you’re simply reinforcing your conscious brain. What you’re doing in physical therapy, you’re working through the physical part of the body, which is unconscious brain. The somatic work turns out to be a huge part of this process, where talking can be helpful, but talking by itself generally doesn’t solve the problem. I think physical therapy is one of the ideal venues for this whole process.

I would love to have you back on the podcast. Can you tell everyone how they can find out more information about you?


I have a website, It’s open source. You don’t need to register to get on it. It will always be that way for lots of reasons. My book is Back in Control: A Surgeon’s Roadmap Out of Chronic Pain, on Amazon, Barnes and Noble. A lot of bookstores carry it now. The book’s going national pretty quickly. My personal goal is to get physicians to listen, understand the whole problem. You just pointed out the classic story that there’s a whole bunch of issues there that you could get physical therapy forever, it wouldn’t solve the problem. Medicine is moving very quickly. We all need to just slow down and listen and solve the problem. I’m pretty easy to find.

It’s been wonderful having you on the podcast. For all our listeners, please make sure you share this podcast with your friends and family. Of course, go into iTunes and give us a five-star review so we can help spread the message on how we can heal chronic pain 100% naturally.

About Dr. David Hanscom, MD

HPP 039 | Non-Surgical Spine CareIn Back in Control, renowned spine surgeon Dr. David Hanscom explains his groundbreaking approach to conquering chronic pain without surgery. Drawn from his work helping hundreds of patients make a full recovery, this book enables anyone suffering from chronic pain to regain control of their care and their life. Dr. Hanscom is a frequent and accomplished speaker on the subjects of back pain, chronic pain, and the DOC program.  In addition to treating thousands of patients with the DOC protocol, Dr. Hanscom has presented the program to numerous hospitals and organizations around the country. The following groups have consulted with him about its implementation:

  • Swedish Medical Center, Seattle, WA
  • Department of Labor and Industries, Olympia, WA
  • Premera Insurance Company, WA
  • Puget Sound Sports and Spine
  • U of Washington Pain Center
  • Northwest Sports and Spine, Bellevue, WA
  • Henry Ford Hospital, Detroit, MI

Dr. Hanscom is an active member of the North American Spine Society.  He is also a member of the Washington State Orthopedic Association, Washington State Medical Association, and the King County Medical Society.



The Healing Pain Podcast features expert interviews and serves as:

A community for both practitioners and seekers of health.
A free resource describing the least invasive, non-pharmacologic methods to heal pain.
A resource for safe alternatives to long-term opioid use and addiction.
A catalyst to broaden the conversation around pain emphasizing biopsychosocial treatments.
A platform to discuss pain treatment, research and advocacy.

If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at Experts from the fields of medicine, physical therapy, chiropractic, nutrition, psychology, spirituality, personal development and more are welcome.

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Dr. Joe TattaNon-Surgical Spine Care With Dr. David Hanscom, MD
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  • Laurie - July 15, 2017 reply

    Thank you for this podcast. Dr Hanscoms words echo the treatment goals I aim for in my physio work. It is great to get validation but more importantly a valuable resource to direct patients to.

    Dr. Joe Tatta - July 17, 2017 reply

    Hi Laurie! Thank you for sharing your thoughts. This was one of my favorite podcasts.
    As a physio it’s great to have this type of in-depth conversation with a spinal surgeon on a deep biopsychosocial level.
    Dr. Hanscom and I may plan something more in the future as we’ve received such a great response to this.
    Stay tuned for more. Make sure you sign up for my practitioner list here:
    I’ll be sending out information specifically for practitioners and don’t want you to miss anything.
    BTW– where do you practice? Patients are always emailing me looking for good PT’s!

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