David Hanscom, MD is an orthopedic surgeon who was in practice for more than thirty years. Upon discovering that most spine surgeries created more pain than before the surgery and even addiction to pain medications, he quit his surgical practice in 2019. This is because through his own personal experience with chronic pain, he discovered a self-directed approach that has since helped countless others to go pain free, mostly without surgery.
Today, he devotes his time to educate others including health professionals and any individuals who want to learn the process – on how to go pain free. He has written a book, Back in Control: A Surgeon’s Roadmap Out of Chronic Pain, and a new website, which provides the action plan of the book, and recently released a guided process, the DOC (Direct your Own Care) Journey. Salonpas sat down with Dr. Hanscom to learn more about his journey:
If spine surgery can result in more pain, why do people have it?
The problem is that patients are not presented with the correct data. Many of the surgeons are also are not aware of it. There is not one research paper that has ever shown that a spine fusion is effective in relieving LBP, especially compared with carefully thought out non-operative care. The success rate for this procedure is between 20-30% at two years from the surgery. What is particularly problematic is that it has been clearly shown that disc degeneration, bulging, ruptured or herniated discs, arthritis, “bone-on-bone” are not causes of back pain, yet it is the most common reason to perform low back surgery for pain.
The data shows that fewer than 10% of spine surgeons are following the recommendations to optimize surgical outcomes.
It is the reason I wrote my most recent book, Do You Really Need Spine Surgery? Take Control with a Surgeon’s Advice. It is a quick read for the patient and presents the known data that predicts success or failure with surgery. Over the last few years of my practice, as I became better with implementing rehab prior to surgery, I was operating on less than 5% of my new patients. They either got better, did not like the odds of a successful outcome, or just did not think their pain was severe enough to warrant the risks.
Tell us about your own experience with chronic pain? When did it start, and how did you reduce it?
It begun suddenly in 1990, at age 37, with a panic attack while driving over a bridge at night. Over the next 13 years, I developed 16 other symptoms caused by my fired up nervous system. They included migraine headaches, tension headaches, mid-back pain, tinnitus, burning in my feet, migratory skin rashes, anxiety, OCD (obsessive compulsive disorder), major suicidal depression, tendonitis, and the list continues. This link provides more details of my ordeal.
I had no idea what had happened or what was continuing to torment me. I sought every treatment and diagnostic test possible without success. In 2003, I picked up a book, Feeling Good by David Burns that suggested that I begin to write in a specific format. Within two weeks I felt a shift in my mood and pain. I thought the change was from the book, which is a wonderful book. But turns out that the expressive writing was a major factor. It is still always the starting point for every patient who has healed from pain.
Six months later, after I came face-to-face with my abusive past and anger, all of my symptoms resolved. I now understand how much effect that anger has on the body’s inflammatory response and why letting go of the past is so critical. I had completely repressed it.
The DOC (Direct your Own Care) journey reflects my experience out this miserable situation. The reason is that it has been so consistently effective is that I pre-tested every millimeter of this pathway for over 15 years and first tried an endless number of approaches that did not work. I kept pursuing avenues that seemed to move me forward and that is how the sequence evolved. Over the last five years the neuroscience research on chronic pain has clearly outlined the nature of the problem and the DOC process keeps being refined based on new insights. The key is understanding the body’s response to sustained threat and how to create safety with a favorable chemical environment.
Can you share your multi-pronged approach to calm which can help minimize or eliminate pain?
The DOC process is a framework that presents proven medical treatments in a systematic and organized manner. Each recommendation is backed by deep basic science and clinical research. My vision for the last 30 years has been to “implement what we already know.” It allows each patient to discover their own unique solution, which always involves a combination of treatments.
The core of the solution is switching the body’s neurochemical profile from threat to safety. Threat is both mental and physical. Examples include predators, bullies, poverty, incarceration, chronic pain, dysfunctional family with abuse, unpleasant repetitive thoughts (URT’s), negative emotions, and repressed thoughts and emotions.
Mental threats are the bigger problem because humans cannot escape their consciousness. The body’s response with stress chemicals and inflammation is similar regardless of the source of the threat. If the threat is sustained, ongoing exposure to this inflammatory reaction destroys tissues and causes chronic disease. One outcome is increased speed of nerve conduction with increased pain.
The key to solving pain has three parts. The first is awareness of the neurochemical nature of chronic pain and the principles behind the solution (calming the threat response). The second is simultaneously addressing all the factors that are affecting your pain. Everything counts. The final step is that since chronic pain is complex and each individual is unique, the only person who can solve the pain is the patient. He or she must take control of their care.
Specific ways of calming down a hyper-vigilant nervous system include:
- Education – My book, Back in Control: A Surgeon’s Roadmap Out of Chronic Pain reflects my 15-year perspective of suffering from pain and provides a framework to move forward.
- The DOC Journey includes an app that guides people through a sequence of awareness, hope, forgiveness, and play. It is intended to create an experience and a feeling of safety, which favorably affects the body’s chemistry.
- Specific tools include:
- Restful sleep – it is the foundation of the rest of the process. Lack of sleep induces chronic pain.
- Expressive writing – write down random thoughts and tear them up. It is an exercise that separates you from your thoughts and has been documented to be effective in over 1000 research papers.
- Mindfulness/ meditation – calms down the threat reaction.
- Never discuss your pain or medical care – you are only reinforcing the pain circuits.
- Forgiveness – anger really keeps the nervous system fired up and essentially every person that has healed has dealt with hurdle
- The ultimate goal is to shift off of your pain circuits to ones that are productive and enjoyable. They include giving back, play, and regaining a life perspective.
Having gone from a surgeon to an educator, what’s the response from the medical community on your non-surgical, non-opioid approach to minimize pain?
My main focus has been on the patients and I would conservatively estimate that I have seen over 1,500 become free of chronic pain. Their situations often represent the worst case scenarios. One patient had 27 surgeries over 20 years and has been pain free for over 4 years. He did it on his own with guidance from the DOC process. So, my emphasis has been on the patients, which has been inspiring and energizing.
The physical therapy and chiropractic world has been open to these ideas. There has already been a lot of movement in their arenas to stay current on the neuroscience of pain, and they are moving forward quickly. They have appreciated the additional perspective of the DOC process.
Although, there is some acceptance from primary care physians with this approach, it has not been embraced by the specialists and hospital systems. The DOC process is largely self-directed with minimal cost and risks.
Please share a typical day in your life; from when you arise to when you retire.
I begin my day around 5:30 AM and spend about 8-10 hours a day ramping up the DOC project. Every day I devote a lot of time on projects that include: my weekly blogs for my website, Psychology Today and Pain News Network. I also spend time preparing for my podcast. I’m always contemplating and reviewing research for a regular group I lead where anyone can join and Zoom in to ask Q + A in regards to going pain-free. And there’s a weekly think tank I’m passionate about that takes place every Wednesday evening with experts from around the country where we discuss and inform new methods to solve chronic disease and pain.
I have dinner every night with my beautiful wife Babs. We take walks in the evenings and sometimes play ping pong and we support each other in turning off the electronics for at least one day over the weekend.