Shireen: Dr. David Hanscom defines chronic pain and discusses the physiological and environmental origins of chronic pain. He talks about how to deal with chronic illnesses such as diabetes using neurological and anti-inflammatory tools. Tune in to learn about how people can pursue dynamic healing as an alternative to mainstream chronic pain management. 

Podcasting from Dallas, Texas. I am Shireen and this is the Yumlish podcast. Yumlish is working to empower you, to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week. 

Shireen: 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 his own 15-year battle. He eventually escaped from the ordeal and discovered that mental pain is the biggest issue. Anxiety is the pain. Welcome Dr. Hanscom. 

Dr.Hanscom: Thank you for sure. And I'm very happy to be on. 

Shireen: An absolute pleasure having you on. I want to start out by asking you a little bit more about your orthopedic surgery practice, sort of your focus there. And then if you can tell me a little bit about what we read at the end of your bio, anxiety is a pain. Can you walk us through that? 

Dr.Hanscom: Well, my journey has been very humbling. I went to a very high level spine fellowship back in 1985, 86, and I was one of the surgeons who came out with a zeal to do surgery on everybody. I could do surgery on. I was just certain, I actually felt guilty if I couldn't do surgery. And then the data came out in 19, oh, by six years into my practice. Over seven years into my practice. The success rate of a back fusion for back pain was 22%. And I just stopped. I thought it was 90%. The data wasn't really there yet, so I just stopped. But after that point, spine surgery gone through the ceiling, almost $20 billion a year of spine surgery to be done right now, based on a surgery that doesn’t work.

So I just stopped doing spine surgery. I did not know it happened to me, but I went into chronic pain myself. So I went from being this fearless major surgeon,  lots of scoliosis, lots of complex infected spines, 8, 10, 12 hour surgeries. And so I kept doing that part of my project, but I stopped doing fusions for back pain.

So around that time I developed chronic pain myself and that included crippling anxiety. And I thought anxiety was a psychological issue and I got help. And the harder I tried to solve this anxiety thing, the worse it got. But I went from being a fearless major spine surgeon to crippled with anxiety, and I was still able to perform spine charity and do my practice. But my personal life is just a disaster. 

And so I came out of it somehow by accident in 2003. And I didn't know it. I still didn't know what happened to me, how you got into this, how I came out of it. And in addition to the anxiety, I'd another 16 different physical symptoms. My ears are ringing, migraine headaches might be burning. Skin rashes were popping up over my whole body. Of course, it's all sorts of medical care and nobody could tell me what was going on. So when I came out of it as equally as perplexed, because I have no symptoms. And I don't have anxiety. 

And so it turns out that the bottom line of all of these symptoms is anxiety is not psychological. It's just a word that describes your body's chemical state when you're, when you're under stress. And what got me in deep trouble is that spine surgery is tough, really tough. And our badge of honor is being really tough. My way to cope with anxiety historically was to bring it on. And I actually prided myself on an indefinite amount of stress, but the problem is that stress takes a toll and people think stress is psychological. But what happens when you're threatened, when every, any living creature is threatened, your body responds to that fight or flight response, that sensation is anxiety. When you suppress it is even worse.

So it got me into trouble because I suppressed everything and being a spine surgeon is a little insane. And you just bring it on. So what happened was, I was 37 years old. I went from being honest. I didn't know what anxiety was and then had a panic attack one day. And from that point on, for the next 15 years, I was just a miserable, miserable human being.

Shireen: And when you, when you sort of, when that did happen for you, I mean, what, what was the path, where does journey? How did it look?

Dr.Hancom: So when it happened, I thought my anxiety was psychological. So I went through all sorts of counseling and talked to different people. And what, I didn't understand anxiety is generated out of the unconscious brain. And so the more I talked about it from a neurological standpoint, I was putting more attention on the problem. And so it was reinforcing these circuits. And so anxiety and anger, survivor reactions, is part of the unconscious brain, which processes about 20 million bits of information per second. The conscious brain processes 40.

So my mind over matter of course didn't work. And so by the time I got to 1997 or so this was about 20 it's, about 10 years into this whole process and developed, which was called obsessive compulsive disorder, which is the ultimate anxiety disorder. And that lasted for seven years. And I was totally beside myself, so I was still practicing again. My personal life has fallen apart very quickly, so I could function in a structured situation, but he couldn't function out of the structured situation. 

So what happened around 2003 is I picked up a book called feeling good, but David Burns. And David Burns said to do these writing exercises. And I thought it was his book, which partially it was, it's a great book, but it turns out that this thing called expressor writing has over 1200 research papers documented that it does all sorts of stuff. So it decreases viral load in HIV. It improves kidney function. Liver function improves wound healing, drops down, anxiety, depression, and improves school performance. I mean, it's unbelievable what this thing does. There's over 1200 references, documented, documented that expressive writing works, but I didn't know that at the time.

So I just started writing. It was in two weeks after 15 years of absolute misery, things started to change. My mood is better. These crazy thoughts started to disappear. And at six weeks I was quite a bit better. And six months later I had lots of personal stresses that were pretty horrendous and I was angry. But I didn't know it, you know, the stress became so high that I just sort of exploded and I didn't process my anger very well, but within six weeks after I went through that gauntlet, which took about six weeks, my symptoms started to disappear and they're gone. My ears don’t ring. My migraines are gone. My feet don't burn. I don't have any of those symptoms. And it turns out this thing we call anxiety is just a word that describes our body's chemistry as a result of stress, not the cause. 

So as I went back to my practice, as I started talking to people, I would do these workups. Sometimes I would see, see an anatomical problem sometimes. But I remember one, two week period. I had four gentlemen, all ages between 45 to 60, all extremely successful near surgical lesions. They needed surgery. But I talked to him and it looked at their spine questionnaire and every one of them had a 10 out of 10 on anxiety, depression, and irritability. So I started asking a simple question. Well, what's going on? Well, there's loss of jobs, daughters, sick with leukemia, business deals gone, bad relationships going sour. And when we started applying the principles of simply learning to regulate your body's chemistry, calm things down. All of a sudden all of their symptoms disappeared, but I asked him the question and often said, look, if I could do surgery to get rid of your leg pain, they all had leg pain. They all had bone spurs. Or you live with anxiety, the rest of your life. What would you choose? Every one of them thought I said, I can't deal with the anxiety. Then I  started asking that question more and more and more in terms of it coming to find out that people can sort of deal with physical pain in a way.

But there's mental pain, the relentless anxiety just drives people crazy. It just means you're trapped. So that was a huge insight for me. I'll wait a second. So then I, then about two weeks later, two people, I had two people flying from New York to Seattle to come see me. Both had had two spine surgeries and it looks at their scans and try to figure things out. And I had the same conversation and they both had the same thing. It was anxiety. And as their anxiety dropped down. In other words, they normalize their body's chemistry. The symptoms disappeared. These are surgical lesions, identifiable bone spurs.. 

Then I started doing this process before every patient I did surgery on in the last eight years of my practice, I would have people work on all the things that affect pain. I called it prehab rehab before surgery and I had over a hundred patients with very significant bone spurs, pinched nerves, matching symptoms that would have done well with surgery. But as we calmed them down, their symptoms disappeared.

So I sort of started putting myself out of business because at the end of my practice, I was operated on 4.6%, 4.6% of my patients. And normally asserted operates at least on 10%, maybe 20 or 30%. Sometimes it goes down to under 5%. And so with elective surgery, there's a thing called prehab where the idea is to get people sleeping, do your things. It stresses physical conditioning, stabilize medications. Sleep is huge. And as we just did with the data said, people's symptoms disappear. Or if we did the surgery, the results are pretty consistently spectacular. Really nice. Then I found out about three years ago that the data also says you do the perfect operation in the perfect patient. But if they have untreated chronic pain, anxiety, it can make the pain worse, 40 to 60% of the time with the perfect operation. So it turns out that chronic pain from any part of the body, whether it's mental pain or physical pain, gets memorized by the brain. And about six to 12, I'm sorry, it's six to 12 months, then it doesn't matter what you do surgically at that point.

Shireen: So Dr.Hanscom, what you were saying then, is that in, in what you saw, at least on the orthopedic side, you saw that a lot of this pain was sort of rooted in anxiety and stressors. Can you speak a little bit more to those stressors, environmental factors that sort of led to that leads to that pain or what you saw?

Dr.Hanscom: So the basic model of treating chronic disease is that your body can be boiled down to your body’s chemistry. So you can feel safe and content, which is oxytocin, dopamine, serotonin, all these great drugs, and what's called, um, anti-inflammatory cytokines or anybody can be in fight or flight, which has adrenaline cortisol, inflammatory cytokines. And it fires your body up because she changed neurotransmitters from common to excitatory. So what happens? You can be either safe or. What you're trying to do is you're trying to minimize your time and what I call threat physiology, because if you're in fight or flight, you can't heal. So the essence of diseases sustain exposure to fight or flight.

So when you have sustained stress, then your body's going to be in fight or flight. You know, it's a bit, it's a big problem, but here's the challenging part. Avoiding stress is a problem. And the stress is the most stressful as a stress that you can't control. So the idea of stress management is somewhat of a myth. Infection is a misnomer. So the three parts of healing are you have your stresses or your circumstances. Then you have your nervous system, which processes your environment. And we tend to think stress is psychological, but it's not just your, it could be physical threats, mental threats. It doesn't matter.

We do know that if you have a mental threat, that it goes to the same part of your brain as a physical threat, you have the same chemical reaction. The problem with humans is that we cannot escape our consciousness. So things could be going really nicely, taking a nice walk. And you're thinking about your boss who yelled at you where your body's in fight or flight.

So the key issue is that your stress is coming in and then when your stress is overwhelming, your coping skills, you go into threat physiology, right? So much stress, your brain can't handle it. And your body goes into a fight or flight mode. Illness is sustained. The data's very clear that stress kills. And people go well, that's crazy. Well, it's not crazy because what happens if your sustained fight or flight, it's like driving your car down there, freeway in second gear is going to break down and your body breaks down and you develop, you develop all sorts of all sorts of physical symptoms and mental cause your whole body's system is fired up.

It would, I didn't remember until a couple of years ago, this is a whole different story. Is that under fight or flight? If I show up here immune. And so your immune system starts attacking your own body. So it turns out that anxiety, depression, bipolar OCD are all inflammatory disorders. And your body's inflamed.

So I did, so anxiety is really physiological and then things like Parkinson's, Alzheimer's cardiovascular disease, peripheral, vascular disease, hypertension, adult onset, diabetes are all inflammatory disorders. So for chronic disease, both mental and physical, it's all the same thing. So with the stresses, you learn how to process the stress differently so it has less impact on you. So there's ways of understanding what my friend, Bruce Lipton calls, stupid stress. We get worried about things we have no control over. So this is a way of actually separating from the expressive writing, they separate you from your racing thoughts and people forget.

You can try to outrun your stresses, but you can't outrun your mind. So the worst stress by the way, are unpleasant, repetitive thoughts. That's what drives people. I mean, if you start talking to people more closely, we have lots of sensory input and we can calm things down a lot, but we still have these crazy thoughts in our head about self-esteem issues, et cetera, that fortress.

We like to be physically perfect, but these thoughts come into our consciousness, but what happens, they create fight or flight physiology. So as your fight or flight physiology is up, your brain is inflamed and the thoughts get worse. It's a horrible little cycle. 

Shireen: So that's, that's interesting. For the individuals who are listening to this podcast here today, can you help us understand how they sort of live with chronic illness, chronic pain, how they can really transform their lives by tapping into their own sort of dynamic, potentially calming their nervous system. How can they get back in control? 

Dr.Hanscom: So what happened is that's why I quit my practice eventually, because I was realizing that we were doing spine surgery on anxiety, as we calm people down the pain goes away. So I ended up, it was so hard to explain this in the office. I finally wrote a book called back in control, a surgeon's roadmap out of chronic pain. The second edition was published in 2016 and it gives people a framework, understand the whole process. So we just barely touched on it today. It was actually not hard to understand it. Doesn't take that much time. And then last year I've essentially rewritten my book in a way. And it put out what's called the DOC journey. – the director of the care journey. And so sequences are just some basic things to calm things down just to calm down. I mean, the essence of the solution is you want to minimize your time in fight or flight.

And so all these tools, each one of them goes into the circumstances, goes to this charity of your nervous system, goes directly to the physiology so you can intervene at all three points with very specific tools. But what happens with the DOC tourney is that it starts with people's skepticism. They go, well, why am I going to try this?

I tried everything else, nothing else has worked well again, you have to have the paradigm or the treatment model, correct? Before I tried the same thing over and over again, that doesn't even address the problem with pain as a neurological issue. Not psychological. 

If you start to address it as a physiological issue, these tools actually work beautifully. So sequence, as you start with your display, there's a special variety. There's some relaxation tools that actually strictly stimulate the vagus nerve, which is anti-inflammatory. Sleep is number one. There's more of a chance that a lack of sleep actually causes back pain. There's actually a higher correlation of disability with lack of sleep than there is with pain. And so sleep is a big one. And then the final one is on this first leg of the journey, which people just think I'm out of my mind, but what you're doing with your brand new, developing a new nerve system, what's in the old one, it's called neuro-plasticity and your brains can develop where you replace your tension.

So one of the rules we have, this has been incredibly, incredibly powerful as people who simply cannot discuss their pain and cause where's your attention. So you can’t discuss your pain or medical care, no complaining. They'll give you advice, no criticism. What’s that doing to your nervous system? Honestly, it’s programming your brains sorta to be nice. Your body changes from threat to safety, and then the ultimate answer to chronic pain and you to do this in a sequence is play giving back life perspective, et cetera. And of course, I know your world  is focused on dietary issues a lot.

And so I do want to, I know we're not running out of time here, but I do want to focus on that just for a second. You have the input, your nerve system and the output. And if your nervous system is hyperactive, it tastes less stress to set off the fight or flight response. Right? So what happens if your brain is already inflamed? It's a problem. So we know exercise and sleep both decrease the sensitivity of the nervous system, but so does diet as you go, anti-inflammatory diet, remember anxiety is inflammatory. All these other chronic diseases are inflammatory. So people go on a diet and think it’s whatever. Including myself, I'm a surgeon. We don't believe in diets.

I do now. And I'm, I'm embarrassed that I didn't pay more attention to this earlier, but if you have an inflammatory diet, you can do all these other things. And I mean,  an anti-inflammatory diet by itself is not going to solve the problem, just saying nothing by itself can solve the problem because chronic pain is complex. But if you're on a really bad diet, forget about the weight, just the diet itself, high processed foods. It's going to, it's going to inflame your nervous system. It's going to inflame everything. So the key issue is you have to address all the issues and diet sleep exercise are right in the middle of it. And you refer to this your whole life, but it really helps people understand that as you do these sayings, you're stimulating the vagus nerve, which is anti-inflammatory. As you drop down your inflammatory markers, your anxiety drops and the pain drops, the pain goes away. 

Shireen: I like, so I like the way you're putting it, essentially what you're saying is what we're constantly hearing. You know, work on, work on the diet, work on the sleep, work on, work on all of these elements because there's a holistic approach in what you're saying. And what is the impact from that on all of these different stresses which then impacts sort of that chronic pain, right? So it's, it's, it's that ripple effect. If you can, if you can sort of take care of all of these environmental personal, all of these different factors, you can then eventually solve their chronic pain. Right? The other part of this then becomes Dr.Hanscom, I guess I, I'm not sure how else to put it, but is it really that simple? Especially when you've got things like genetic factors, when you talk about, okay, there's only so much in my control, but then there's genetics. There's all of these other things. how would you, what would you say to that, to all these other elements that are in play that are not in our control?

Dr.Hanscom: So you could not control the vast majority of everything, but to you, you can control your response. So remember stressors are not the problem but rather chemical reactions that cause distress. And I just talked to Bruce Lipton last week who's a friend of mine and he's extremely hyper about that phrase, about genetics being a problem.

We are not at the mercy of our genetics. Our  environment goes to the genetics that can get expressed. Just because you have a breast cancer gene does not mean you're going to get breast cancer. So again, under stress changes, the body's chemistry has a much higher chance that your resistance is down and you'll have cancer.

And it's a real debate about the link between stress and cancer, but there's a clear difference between stress and carnage disease of all sorts. Any chronic disease is chronic stress. So, the key issue is that you can't control the  stresses, but you have a complete scale of the reaction. And I call it the eye of the storm.

We're. If you think about the wind represented in your circumstances that you can't control and your racing thoughts that you can't control, but here’s a tool that plays into this. As you quit fighting things that you can't control, then you have much more energy to deal with what you want to deal with. See, the problem in chronic pain in general is they're always trying to fix yourselves, right? Our brain is focused on the problem, not the solution. So the way the process works, and it's not just my process in principle, anxiety, and frustration and anxiety, anger and frustration are all reactions. So as those reactions come into the present moment, the tool assembly separates you from the past, not solving it, not fixing it and not trying to alleviate it.

This is why it is disturbingly simple because the tools that negate these obsessive circuit patterns are very simple. They're not hard at all. Then you can give back, play with friends, family, doing things that you enjoy. So visualizing the life you want is really critical to pursue that. And that's how the solution in chronic pain is actually developed in this new nervous system. So moving away from chronic pain is like any musical instrument that you don't play for 30 years, it's going to atrophy. If you pick it up and move forward, we have play circuits in our brain. We know how to get back. We know how to be with people. That is  genetically hardwired. So there's this part of the anxiety. Frustration in the unconscious brain. My friend Bruce Lipton says really clearly it's a hard drive. You must be talking to a machine that is not going to respond to your entreaties, but what does respond is this developing your consciousness that you want.

What do you want? You like to look ahead, but you can't do that if you're fighting anxiety and frustration, SO  it's a separation then moving forward. And if you want to call learning how to play, giving back work. We can call it that because it is fun.

 I think what makes me so frustrated is that spine surgery is complicated. The downside of failed spinal surgery is horrible. And these tools in this collusion just are disturbingly simple. And we have hundreds of hundreds of patients that just are living a life they never do as possible. They not only break free from pain, there's a span of their life into this new reality. They're so excited because your brain is physically changing that direction. Once you hit a certain tipping point, you'll fall back a lot, but you have the tools to get out. And people actually can't turn back because they own it from day one. So it's, you've changed the way you process life.

Your brain starts to structurally change and people, I went to them in 28 surgeries in 22 years. He's 67 years old. He says he has never felt better in his life. It would be for chronic pain. And it gives a bit of a story behind that as you can imagine, but I did not think that was possible. So I'm convinced you can program your brain around essentially anything. 

Shireen: And this is, this is, I guess, even on the, on the flip side of it is putting a lot of onus on the individual to make change, right. Or if you look at any kind of surgery, I mean, even not maybe spine surgery, but if you look at it as like, well, there's, the answers are quite fixed as a surgery and it's, and it's done, but where you're seeing is that it doesn't need to go that far. You don't need to get as invasive in the approach. There's a lot that can be done that the individual can do in their own life to sort of manage that pain and, and work on. 

Dr.Hanscom: Well, I mean, spine surgery is a big deal. It's not a quick fix, it's months of suffering. And then you're worse afterwards with a 20% success rate. So this actually is a quick fix within two to four weeks after we will start learning to calm the nervous system down, though it should be given we're not fixing your pain, we're giving you tools to allow you to fix yourself. So it's a hundred percent on you. And the problem is when you're angry and in pain and trapped, you tend to blame people around you. So you're sort of used to not taking responsibility, including myself. So I don't want to sell luxury here. So there's nobody better than a surgeon for blaming people for anything. That's what we do. But in pain, in pain, same thing, people blame everything. So there's, that is the biggest block by the way to healing is actually saying, okay, I can do this. I'm taking responsibility. Once people do that, it’s game on.

Shireen: Before I let you go, Dr. Hanscom, I have to ask. So at Yumlish we work with people who have, um, you know, diabetes or pre-diabetes, what, one to two things, would you tell someone who is trying to deal with that? Trying to figure that out, in addition to what you've already mentioned, what are some suggestions you can provide for our listeners for taking ownership of their healing? 

Dr.Hanscom: Yeah, it's a little tricky because all of us tend to say, well, I'm going to try this diet or try exercising and et cetera, et cetera. And the key issue here is it's always an accumbent combination approach. And so the first thing we have people to sort of calm down with breathing exercises, et cetera, is what happens when you're upset and in fight or flight. Your breath, your blood supply to the brain changes. You go from this thinking center to the survival centers and you can't think clearly. So learning does common techniques to start rationalizing, rationalizing things better. And we're looking at behavioral changes. And so when you're not taking care of your health, as well as you should, then why is that. You're so busy trying to survive. You don't know how to take care of yourself anymore. So I would encourage you to learn the tools to just negate these circuits from the past and learn the tools and move forward. And it's like learning how to become a golfer. It takes lessons and reading books and actually practicing.

So as you practice the skills to learn how to regulate your body's chemistry, you have control. And that you mentioned collude your diet, et cetera. So that's where the sequence is so critical to sort of get calmed down enough, understand the problem. Then again, the solution is, is what I call it, disturbingly simple.

And all of us have, this is an entirely different conversation, but it turns out the more resolute you are and your resolutions to get better and do better, the lower, the chance you're actually going to do. Because it might never matter, does it work? So you're looking to actually change the structure of your brain. And so you can't, you can force yourself to sort of become better for six months a year at the most, then your conscious mind just sort of wears out. It goes back to the old patterns. So this is actually changing the structure of your brain. You're changing the filter. Once you've changed the filter, where you look at life in general, your brain keeps changing.

So maybe for the first month or two with your type of program you started to do well, then you start falling off and you give up. So you want to change a filter to learn the skills that you can move forward indefinitely and people do. And so I guess about behavioral changes and all of us want to be healthier. We don't do it as much as we should. Right? Because it's behavior. So it starts by taking a long, hard look at those behaviors and understanding why the change is important. 

Shireen: Perfect.  Dr. Hanscom with that, we're toward the end of the episode, before I let you go, I would love for listeners to learn more about how they can connect with you and learn more about your work.

Dr.Hanscom: Yeah. So, um, I have a book called Take Back Control: A Surgeon's Roadmap Out of Chronic Pain. And for those of you that have back pain or are considering surgery, I quit my practice to do this two and a half years ago. It’s called Do you really need spine surgery? And it's a quick read and just clarifies as a decision making really easily into two factors. The anatomy and the nervous system. And then the most recent thing that we have out, which is happening now, is called the DOC journey. Director Your Own Care journey. It can be accessed through thedocjourney.com. And that's the sequence I'm telling you about, about starting slowly, letting your brain build and change.

And so. It's been really delightful, watching people more consistently get better, more quickly. And the one factor that determines success is whether you're willing to engage and learn the tools. So again, my excitement is watching people's anxiety. Mostly anxiety drops, the pain, physical pain also drops. Then all of a sudden they start creating these lives that are fantastic. And they're so excited. And I would come into my clinics every day, just totally fired up because there's so many successes. People are so excited. So yeah, it's a very self-directed process. And then, you know, I have talked before that if you have a chance to do it, which you're doing, which is more focused on a specific part of the problem. Remember, this whole problem is complicated. So, you know, the diet stuff is extremely helpful. And then you had these other layers in around it. Not very hard. We recommend maybe 15 to 30 minutes a day at the most looking at this stuff. And so, yeah, that's, that's where you’ll normally find it.

Shireen: And to our listeners out there who are listening to this episode, had a return or a social media post after this episode and let us know what is the one step you are taking to treat your chronic pain, head over to our Facebook. Let us know there. What is that one step that you are taking to treat your chronic pain and with that, Dr. Hanscom, thank you so very much for your time. It was an absolute pleasure having you on.

Dr.Hanscom: Thank you. I totally enjoyed it.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.

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