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

What kind of a surgeon tries to talk you out of surgery? An enlightened one? Seattle-based Dr. David Hanscom has been performing intricate spinal procedures for over 20 years. He has also suffered from severe burnout, debilitating back pain, and anxiety disorders. After much investigation and personal soul-searching, he shares his revelations in his book, “Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain,” for all those contemplating, getting ready to embark on or frustrated with surgery of all kinds.

Chronic pain affects approximately 116 million Americans. An astounding one-third of the population live with chronic pain, dealing with everything from back pain to temporomandibular joint dysfunction (TMJ) as well as arthritis and migraines. Within the past five years, the number of back surgeries performed has surged. And although spine surgery does have its place, the actual rate of success is very low. According to Hanscom, the majority of all back surgeries can be prevented.

Really? How’s that? Well, apparently not all pain has an identifiable source. Picture the good doc Hanscom pouring over copious scans trying to find the source of the tirade he has just witnessed from an unhappy patient who is suffering from extreme discomfort. Scans look normal. No evidence of any kind of structural problem. But the patient’s pain is real. Certainly it is to them. How can that be? Where’s it coming from?

Hanscom writes in his book that “recent neurological research shows that the brain can create pain that is identical to the pain of a physical injury.” And that “stressful events and our emotional reactions to them can make that pain severe.” OK, so does that mean the pain is in our head? Think of those phantom limb cases where amputees continue to feel sensations where their limb used to be. If our pain is indeed programmed neurally, then it stands to reason it can be reprogrammed neurally.

To Hanscom and others, that’s the key to solving chronic pain. It’s through neuroplasticity — the reprogramming which actually turns out to be the creation of new pathways — that we address how we deal with our pain. The pain pathways will never go away. They are there forever. But we can calm our central nervous system (de-stress), detach from our negative thoughts which amplify the anger-anxiety cycle, and then pair new physical sensations with new thoughts to create new pathways. Eventually as the central nervous system switches over to the new pathways, the old ones will seem, well, simply antedeluvian, just a lot of history.

Hanscom’s five-step holistic, mind-body approach which he calls “defined organized comprehensive care” (DOCC) is meant to address the “mind-body syndrome” and help all those suffering cope with pain, and the anxiety, depression, and anger that accompany it. Customized for each patient, it involves stress management, anxiety reduction, and improved sleep. Self-help books are great, he says, and he’s read many which he recommends to his readers. But unless you do the work, he further cautions, the information can just feed the complexity of the problem rather than activating a solution.

Hanscom believes that it takes actions like “free writing”: a process whereby one writes down negative thoughts and then throws the paper away that enable a true separation from the negative thoughts, acting as a circuit-breaker to the anger-anxiety cycle that feeds the pain pathways. Hanscom advocates the need for a good night’s sleep (even if it means taking medication to establish it at first), becoming aware of your anger, anxiety, and victimhood, releasing negative thoughts to calm the central nervous system and ready it for reprogramming to a more authentic, mindful existence.

Though Hanscom’s DOCC focuses on relieving back pain, it is applicable to all kinds of pain. His book stands as a synthesis of the many instructions, tools and understandings he has had throughout his career as a surgeon dealing with people in pain every day and his own journey towards living the life he was meant to live — happy, rewarding, and pain-free.

David Hanscom, M.D. is an orthopedic spine surgeon in Seattle, WA. His website is

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