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Stage I

Address Anxiety

OVERVIEW OF Stage I

There is a tremendous amount of anxiety and frustration associated with being in chronic pain. Not only are you trapped by the pain there does not seem to be a way out. This stage is focused on processing anxiety and educating yourself about the variables that affect pain. This is the first of five stages.

  • Engage–NOW! Just reading is not effective.
  • Deeper understanding will evolve.
  • The main predictor of success is openess and committment.

GOALS of Stage I

Education

Sleep

  • Improve by at least 50%
  • Usually requires medications

CNS

Medications

  • Adjust so as to experience 1) decreased pain 2) decreased anxiety 3) improved sleep
  • Do NOT try to wean off any meds—the goal is to stabilize them

Goal Setting

Rehabilitation

  • Learn basic spine mechanics/ anatomy “Eight Steps to a Pain Free Back”
  • “Back School” if available
  • Hold off  doing physical therapy until your central nervous system begins to “calm down”
  • Join a gym and engage in light training with weights  A New Life at 82

FIVE STEPS:

Step 1—NAIL DOWN YOUR DIAGNOSIS

There are two fundamental aspects to the perception of pain:

The source

  • Could be a structural problem
  • Inflammation of the supporting soft tissues
  • Your own nervous system – Mind Body Syndrome  “Short Circuits”

The receptor—your brain; the following factors contribute to the central nervous system’s perception of pain

It is critical that you learn about the source of your pain.  It is assumed that you are already pursuing this with your doctors.  If there is a structural problem that is solvable with surgery then it needs to be done in the context of “shared decision making”.  However, I feel that over half of spine surgery should never be performed. What many surgeons are defining as “structural” is simply normal aging anatomy.  Disc degeneration is not a disease and not a reason to perform surgery. Back Pain vs. Mouth Pain

Video: “Get it Right the First Time”

Surgical Results Overly Optimistic

Step 2—”You are Not Your Thoughts”

You cannot control your pain or the anxiety and frustration associated with it. The Terrifying Triad It has been said by philosophers for centuries, “You Are Not Your Thoughts”.  Associating thoughts with physical sensations forms neurological pathways.  Writing down your negative thoughts creates a space between you and the paper and associates that space with vision and feel.  With repetition you will separate from your thoughts.  Your anxiety and then frustration will abate. Somewhere within this process the pain dramatically decreases and often disappears.

Your journey to a pain-free life will begin the day you commit to writing.  It will not start until then.  Write and Don’t Stop

1. WRITE DOWN YOUR NEGATIVE THOUGHTS AND INSTANTLY THROWN THEM AWAY.

  • Don’t just write about the thoughts, write down the actual thoughts.
  • The reason you are throwing them away is so that you can write with complete freedom.
  • Do this once or twice a day for 15-30 minutes per session.
  • Do not try to “journal” or keep these writings.  It is counter-productive.
  • Write in this free-flow format for a couple of weeks before you engage in the “Feeling Good” format below

2. WRITE IN THE “THREE-COLUMN” FORMAT

  • Read the first third of David Burn’s book, “Feeling Good”
  • In addition to free writing, write in his “three-column” format
  • This format represents the phases of reprogramming: 1) awareness 2) detachment 3) establishing new circuits
  • This a great book but not effective without writing Letter from David Burns
  • Continue to IMMEDIATELY destroy your writing

Your nervous system is hyper-reactive.  With chronic pain your brain lays down pain pathways similar to you knowing how to ride a bicycle.  This is not a “psychological” problem so traditional psychological approaches do not work. Once you know how to ride a bicycle you cannot unlearn to ride it.  The strategy that is effective is “re-programming” these circuits.   Writing is the foundation of this process. Your Demons are Robots

We have learned that there are many additional strategies that are helpful in decreasing your pain but all are in ADDITION to the writing.  There is not an alternative that has been as effective.

Step 3—Neurological Pathways – Not Psychology

  • Read the book “The Talent Code”. It is a book that shows how the brain forms neurological circuits in response to repetition.  Dan Coyle is a wonderful writer and he clearly elucidates how genius is formed in athletes, musicians, and artists.  He links it to recent neuroscience research showing how the brain lays down myelin to imbed these performance pathways.  The same principles apply to anxiety, pain, and the associated frustration.   Forming Neurologial Pathways-”The Talent Code”
  • Read “White Bears and ANTS”.  Dr. Daniel Wegner in 1987 published an elegant paper demonstrating that when you try not to think about something, you will think about it more.  The darker the thoughts you can get down on paper the more effective the writing process.
  • Read Dr. Wegner’s essay, “The Seed of Our Undoing”. Writing negative thoughts is a discipline every human should be doing from childhood.  Without implementing techniques to “maintain” your nervous system you will eventually begin to buckle under the “ironic effect”. No one escapes the relentless progression of these circuits.
  • Living with chronic pain intensifies negative thoughts.
  • You cannot “fix” your nervous system.  You can only engage in strategies that allow healing. A Bunch of Balloons
  • The irony is that the solution is so simple.

Step 4—GET SOME SLEEP

Sleep is number one.  The only reason that I placed the calming down of the nervous system ahead of sleep is that the same tools will help you sleep.  None of the DOCC principles will be effective if you are not getting 7 or 8 hours of restful sleep. There are medication combinations that will allow you to sleep regardless of the level of your pain.

Not sleeping is NOT an option.  Not one major decision regarding your spine care should be made until you feel rested during the day.

Step 5–APPLY DOCC PRINCIPLES TO THE MIND BODY SYNDROME

DOCC Principles

The DOCC model is a framework that organizes well-established spine care concepts.  It allows you to organize your thinking and care to enable you to take full charge of your life.  Your providers are resources and coaches.  The concepts are the polar opposite of what most of us have been taught regarding how to manage pain and stress.

  • Print the outline of the book, “Back in Control” to provide an overview the DOCC principles.
  • Although all of the resources to become pain free are contained in this web site a full draft of “Back in Control” will deepen your understanding of the whole journey. It may be forwarded to a print shop to create a reference book.  It contains numerous stories of struggle and success.
  • Use this website as a resource.  It will be updated regularly.

Mind Body Syndrome

Recent neurological research has demonstrated that the brain has the capacity of neuroplasticity, or the ability to create new nerve pathways in response to life events.  For example, when you learn to play the piano or swing a golf club, your brain cells have developed a new pathway that is connected to your body.  These pathways consist of thousands of nerve cells. The more that pathway is activated or practiced, the stronger it becomes.  What most doctors do not know is that pain can be caused by this type of learned pathways.  Even when there’s no tissue damage in the body, such as a tumor, a fracture, or an infection, a learned pathway can cause real, physical pain.

My patients’ success is proportional to the degree of their involvement and commitment.  Over time I have observed a consistent improvement in my patients’ pain and quality of life.  Caring for my patients in chronic pain has become the most rewarding and enjoyable aspect of my practice.

RESOURCES:

“The Talent Code” by Dan Coyle

“Feeling Good” by David Burns

8 Steps to a Pain-Free Back by Esther Gokhale

Full Draft of “Back in Control”

“Unlearn Your Pain” by Dr. Howard Schubiner

CRITERIA TO MOVE TO Stage II:

  • Cover the outline of the DOCC project
  • Read ALL of the links in Stage I
  • Understand the source of your pain
  • Know about the Mind Body Syndrome
  • Finish “The Talent Code”
  • Finish the first third of “Feeling Good”
  • Engage in 15-30 minutes of writing daily.  Free writing is important but you should be using the “Three Column Technique” described by David Burns.
  • Sleep should be modestly improved
  • Understand basic spine mechanics through a detailed book or a back school
  • “Back in Control” draft as a reference
  • Don’t move to Stage II for at least 6-8 weeks and you have covered ALL of the above steps.

Don’t rush through any of the stages. It took years for your situation to evolve.  It will take time and repetition for you to heal.

Phase I worksheet

Print Phase I worksheet

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