Chronic pain I mean you're having that pain a surgeon and then having gone through so much pain in your life I mean even back surgery in your life can you talk about that for a moment in medical school are really not taught about chronic pain I went to medical school residency fellowship I really no idea what chronic pain was all about between my residency and fellowship I ended up with 2 back operations and I cannot figure out why people in back problems had so much inability to deal with it I thought their sort of wimps Well it's about 6 weeks I had a ruptured disc I had pain in my left big toe which is the only part of my body that hurt I couldn't sleep I can function 6 weeks later when spine surgery and up with kidney failure all servers post-operative infection I lost my job at the time and with an extremely dark period all around pain and spine surgery. It was not fortunate for me but probably the most fortunate thing that ever happened in my patients was because my empathy level went through the ceiling that was my 1st hint of how bad spine problems could be. And then I went into practice and I worked very very hard and I was successful but I became increasingly stressed out frustrated and I didn't really realize it the hell out of chronic pain issues that I didn't actually recognize. When you didn't recognize them do you mean that you just sort of macho your way through them or what would you do well for instance there's a mind body syndrome which is a real physical diagnosis not just quote mind body situation that these are real physical symptoms. And there's a least 30 of these symptoms of which I had 16 of these symptoms for instance migraine headaches my years burned in my feet insomnia anxiety frustration skin rashes all these different symptoms I was having by had no idea where they were coming from just part of my life and I did where most surgeons do which is mind over matter in positive thinking as her pushed my way through it and then 995 I just had a really bad burnout to go up incredible anxiety developing credible sleeping problems and by 997 I shipped in a full blown call obsessive compulsive disorder and for 7 years I developed a stream pain headaches insomnia and I was in 2002003 that I came out of the hole in a sort of my dumb luck but I found this process and it's been described for a long time but I didn't know those principles and I had read some books and started to write exercises I had tried every possible treatment on a man kind. Really in a really pull me out of the whole is this book called Feeling Good by David Burns and the book is a great book but we're really pulled me out of the hall was a David Byrne said to write so I started to write within 6 weeks of I started to write my sentence started to alleviate. And over the next 12 months things got quite a bit better and then about a year later I came across a fact that I was actually somewhat of an angry person which I had no idea I was angry. I when my 1st lines to my current wife was I miss her I'm sort of a good catch because I've dealt my anger issues. The reality was it wasn't connected to my anger anger issues that you thought that you had handled all your anger issues and you were you were an unlighted bean and you discovered maybe you did have some anchors I didn't have any anger issues. I'm serious I had no clue Yeah but also a section of my book called the disguise of anger and looking backward I had every disguise going that I ever did buy came from a very difficult childhood and when you're come from a difficult childhood anger and anxiety are your baseline not your norm so you are master at masking masking anger I don't know if their lives after a disguise I don't face mask in but that's my frame of reference that just seems normal she came from an angry anxious environment that your baseline you don't know what love really is. Right you get like you're so I mean in the water of anything you don't recognise a water correct princess when I was 20 years old appears to come into my service with things already disorder I had a look the word up I didn't become a major spine surgeon by having anxiety the spine fellowship I went to at the time was considered one of the top 3 spine fellowships in the world I think get there by have an anxiety. I get there by suppressing anxiety and detaching from H.R.T. The trouble is you try not to think about something you think about it Mark and what I eventually found out things are is actually not psychological diagnosis it's a pathways issue anxiety is a classic symptom of the mind body syndrome and the harder you try to control as ID the worse it gets so it is 20 years old this patient came into my service with a jar disorder I had to go to my medical textbook and look up the word anxiety I had no idea it was I truly didn't know what the wordings already meant. Then I was 35 to 30 years old I started having panic attacks and going what's this my heart started to race I started to sweat and going to what is this I had no idea didn't have a clue and finally went into full blown panic attacks I had to get some help some plays and that was my 1st 1st introduction to anxiety but what gets a lot of professionals in trouble are all of us in trouble it's are taught that positive thinking and mind over matter is the way to go and we keep pushing through everything regardless what it does well what that's doing is they can do that for a while if you have a lot of short term success but it really really really fires up the nervous system down to things that you said that I want you to elaborate on one you said you talked about and started writing and wanted to talk about that and the other thing you said is it's a pathway issue so starting with the writing you said I started writing it was a particular kind of writing Now wasn't that with all due respect as I called it they say called is a very important part in our society and in people's lives. But has a different role with chronic pain and anxiety and mind body syndrome what happens with pain is that pain can come from either a structural problem which means you have an identifiable problem with Washington Times. Or it can come from the soft tissues or the generation actually short circuit increase on pain without even having a source so you have a structural problem nonstructural in my body syndrome but you nurses to receive the impulse Regardless no matter what the source in the nerves system then has the . Pathway or has it's own system that's going on right so with repetition the brain there's some pathways like any artist or athlete with the problem with chronic pain is that the impulse to commit so quickly you're taken France the Major League Baseball player it takes thousands of swings maybe tens of thousands of swings to learn how to hit a baseball you probably get a lifetime of Major League Baseball swings in about 3 or 4 months we think within 3 or 4 months of pain pathways to lay down once a pathway is laid down it is permanent and you describe in your book something called Milan can you describe what that is 25 happens there well there's a fast a book written by Dan Quayle called the talent code and he takes the formation of talent any finds out that genius is never born but it creates after 10000 hours of repetition but it leads to general science research about how the brain these a mile and a mile and similar to the insulation around a wire and as he's pathways are laid down in patterns allows you to reproduce their process pentathlete are very very specific to very specific deep learning type of process the repetition is huge and those pathways get laid on very very quickly so it makes life a kind of superhighway neural connection absolutely. That's a great analogy so besides a soft tissue maybe that is causing the pain in the 1st place or structural. Something wrong structurally is causing the pain there's still this other pathway it is highway nerve highway that's going on in the body is that what you're saying Craig So you know the pain path has been laid down but people in Harney pain lose your sense of humor there they're not very happy about it and pain Joyce connect with anxiety and frustration friends is if you put your hand over a hot candle or a fire or a stove what would happen during Friday oh REM You go up and you pull your hand away right away right so your anxiety goes up you pull your hand away what would happen your anxiety forced you to hold your head over that stuff yeah you know I had been very very painful on her in the flesh so it would be your next emotion I would be pretty angry often. And pretty unhappy so they was careful in chronic pain you were trapped. So loss of control and with chronic pain you've lost control of getting rid of the pain one area of a basic human need like air food or water not being met you become anxious and then frustrated with the need continues to be met and not being in pain is a basic human need so people in chronic pain not only have the pain patch was being laid down but we found the anxiety is also a pathways issue so chronic pain is always connected with anxiety and frustration what happens or brings more of the nervous system into that pain signal she epiphytes magnify the signal we're going to continue with this in just one moment I want to tell our listeners that I'm here with Dr David Hans coming and he's the author of Back in control a spine surgeons road map out of chronic pain and if you'd like to check out his website you can go to his website back dash. Dash control dot com back dash or hyphen and hyphen control dot com or you can get there through the New Dimensions website New Dimensions dot org I'm just saying well as Tom said You're listening to new dimensions. I'm just a moment and I'm here speaking with Dr Hans cam David Hans Cameron He's an orthopedic spine surgeon and Seattle Washington and he's the author of Back in control a spine surgeons road map out of chronic pain and we're talking about the pathways the neurological pathways to pain and. Developed in our systemic and tell me more about this is if these pathways are they once they're there what what happens to them and how can we alleviate the pathways are permanent. And just like riding a bicycle you can touch a psychologist or psychiatrist or you want about a learning how to ride a bicycle you're not going to learn that skill is a cannot learn pain pathways for the heart and try to undermine the pathways in touch with you actually reinforce up but going back to the handover stove analogy is that you've also a lot of complex. To the signal she really locked in or in bed of those pathways in your nervous system it sounds rather discouraging but there is a part of the nurses and that's very helpful and that the brain can only do really one thing at a time we think we can multitask but really we can't do what you're trying to do is create alternate pathways around the pathways that are already there with repetition Once you create enough alternate pathways the pain switches go to off the tracks were tied off I get this picture of coming up to the highway and says you know big signs out of order and you know detour ahead and that's what we're doing are we where are you creating detoured on the pathway for those 3 parts of the process is awareness detachment and reprogramming. And what happens why the writing is so critical is that the 1st step in the whole process or 1st of August or mention sleep really quickly sleep is number one nothing else in this process works at all without sleep Leave sleep aside for a 2nd I think he's saying in your book sleep in such a trump card none of this process works at all Michigan sleep chronic pain the medications to snow in our culture where very sleep deprived or Western culture where we're not getting this point need right so the essence of the process we're trying to calm down the nurses' time of course leap is number one all the rest of the book does not work without sleep so what you do with the writing exercises which is the 2nd part of the process is to deal with writing down negative thoughts and throwing them away. What happens is the parts reprogram his awareness to kashrut reprogramming what the writing does and I've never seen him ready by the way you're better without the writing every physician Horsham mind body syndrome principles has the patient writing well we've done a lot of programs on writing and especially journaling I don't think you're talking about journaling this is not journaling what you're doing around only negative thoughts you simply throwing them away you know throw them away to get rid of you should be trying to separate from them and the only reason to throw them away is to revive absolute freedom because the darker more negative the thoughts more effective the process I don't want people to crumple up the piece of paper I want to rip them up shred them burn him you know try your read of yours try to write with absolute freedom because what happens with the writing do to the 3 steps at once you create awareness of the thought but you've also create a space between the thought and you that space is not connected with vision and feel you create pathways by connecting thoughts with thoughts or thoughts at the most and but you also create pathways and 100 thoughts with physical sensations. The process is really starting to start the writing is Ukrainian work around path which in fact if you read my book or any self-help book without doing some type of writing exercise. You've given your brain just more ammunition to think in some ways is counterproductive You know David. You've been doing this process for a while and and we were talking before the interview and you were talking about how your body was giving you feedback again and so you've intensified even now even though you practices for a long time even now you've gone back to your writing practice say something about that I've had 16 of these 33 mind body symptoms and when I quit writing 1st of all my wife goes Honey don't you think you should start writing again and I get more reactive I am not the same person I quit writing saying well it's just like brushing your teeth there's no end point here just like brushing your teeth every day just the way the nurses time works is not I'm a July philosophy so I've been writing for 15 years the 1st 3 years when I was in crisis or would write a lot and it becomes just once things that really allows you to calm down or nurses come in this way no other substitute you can you can say the thoughts I also will stalk in the car to myself which again is another or a logical pathway so you can either write or say the thoughts or you can do some visualizations which is more of an advanced toll but it's found that writing is is like digging the depths so the foundation of the whole project if you say the thought then what do you do with that it's gone oh you just say it out loud and you just release it right but you become aware but she went through the auditory pathway and I don't see you actually say it out loud crack so you're actually physically there's a sensation right of hearing the thought and then it's just released I mean you can't I mean advanced meditators can do this by and generally you cannot calm your mind with your mind what you're doing your use your body your sensory input to calm down your mind and it's extremely effective and I tend to use feel is. Is it right now if I start talking too quickly I just actually feel the chair and that's what calms me down but tell myself talk slower talks for talk's floor that doesn't work so I simply feel the chair and it calms me. David I'd like to talk a little bit because in the introduction I said something about how there are many unnecessary. Spine surgeries going on and when you say something about that whole culture. The way I was trained is that the surgery is the definitive solution for anything with back surety the definitive solution that I was trained was to. If somebody field an operative care then they quote needed surgery and this sort of choice for a back pain problem was a fusion supposedly the disk is a source of the pain you're done if I the desk and you fuse that disk by eliminating the motion in that disk technically you get rid of the pain I one of the few surgeons who's been on both sides of this fence I came out of my fellowship in 1906 I spent 7 years aggressively doing spy infusions. And I had some success but most of time it wouldn't work. And I was incredibly disappointed when markets that they were stolen and what they were get better for 6 to 12 months and then the pain would come back and I'm going what's going on I was taught that in journalism straight of spine surgery for back pain it's about 8090 percent. When the dad acuminata 93 in the state of Washington for mine Dr Gary Franklin published a paper showing that the return to work rate when your true spine fusion for back pain was 15 percent 15 percent tears up to spine surgery success rate of people going back to work was 22 percent then I started as he patients break down above and below their fusions because when you do a fusion and you push press above and below the fusion a sponsorship breakdown I saw one gentleman who had 28 surgeon 20 years and all start of the one level fusion for back pain I showed you next we have a woman who has her done in 1990 she was fusion L 3 to the safe room she ended up in a wheelchair for 20 years because her spine broke down above the fusion. Success rate of a spine fusion we're back to only about 20 to 25 percent there's no data right now to suggest otherwise but that's not what most surgeons will tell you if you go in and ask OK well on once it's going to fix and once my what's the prognosis of recovery it depends on how your tray No worries I was trained that way and surgeons are still being trained that way and I don't want to be negative on a given individual surgical they really are trained to do surgery or patients or else the surgery the primary care physicians are asking for surgery societies asking for surgery the patients are desperate parents companies are backing it up well they're in the middle of this are Washington insurance companies for a policy that they will not pay for fusions period for back pain not going to happen now that's because was surgery you know Mr didn't do a lot of spine surgery but if I can see the problem that is not identifiable structural problems with matching sometimes our success rate is only 100 percent it's very clear if you can see the problem the chance of doing somewhat of a random operation for something she can't see is pretty low. Placebo effects about 30 percent we don't need to put stable fact with a back for back pain which she cut down the perceivable effect on back pain with surgeons are going to cause more problems right away and so successor is around 20 to 25 percent the re operation rate is 18 percent within 12 months so the re operation rate is almost as high as the success rate right than most people what I ask you rip an audience of one percent success rate would you like before you undergo a spy vision for back pain but most people want 80 to 90 percent for a definitive operation to be done. As it would if the operation was pretty perceptive and you know very few people raise your hands but if you do for reality the success rate is around 20 to 20 percent and it doesn't make any sense nothing plus the most common reason for doing a back fusion is for degenerative disc disease Well guess what you genitive dismisses is not a disease is simply part of the normal aging process as you get older you lose water content the desk. They become less mobile and stiffer but there's no association with the disk degeneration and back pain. That clearly because like if you took an X.-Ray of 2 people and they have the same d