Dr. Hanscom's Blog Avoiding surgery by recognizing the “trigger”

[Back In Control Blog]

“Get it fixed”
I am a busy spine surgeon and my approach to a structural problem historically has been to tell my patient to “get it fixed” or decide the pain is not severe enough to warrant the risk of surgery. I felt this approach would be the fastest way to get on with the rest of the DOCC project. I was wrong.
Surgery cancelled??
A few years ago I had a couple of patients come in for their pre-operative appointments for surgery on clear-cut lesions. While waiting for surgery they had engaged in the DOCC project tools and had begun to calm down their nervous system. Their pain disappeared and I cancelled the surgery. Then I had a run of patients who were pretty uncomfortable but just wanted to wait a while before undergoing surgery. They were interested in the DOCC tools and wanted to give them a try. Even in the presence severe spinal stenosis their leg pain would disappear. Again no surgery.
Everyone now engages
Then our team noticed that even if surgery was performed that engaging in the process made a huge difference. Post-operative pain was less, rehab was easier and the overall results of surgery were more consistent. We began to ask all of our patients to engage in a structured program for at least a couple of months before we scheduled surgery. Our practice and patients are thriving.
Better without surgery
I saw a woman about four months ago who was with miserable with back and leg pain. She had severe spinal stenosis at three levels of her lower back. It had been recommended that she undergo surgery to relieve the compression on her nerves to her legs. Since she had mostly LBP and very little leg pain I did not think surgery would be helpful. Back surgery rarely diminishes back pain. She came last week after engaging in many of the tools on this website beaming in that she had essentially no pain in her back or legs, she was sleeping and her mood was markedly better. She could not contain her excitement. I was also pretty inspired.
Not a surprise anymore

I am frequently seeing patients with structural lesions and significant matching symptoms improve without surgery. As their nervous system calms down it seems to raise their pain threshold. It is not a matter of just “living with the pain.” It disappears.
Ray’s letter
Hello, Dr. Hanscom and Linda,
My recovery has been miraculous! Last Thursday’s meeting capped several weeks of increasing pain and increasing oxycodone use. During the meeting, I looked at my “med calendar” to show the correlation between increasing pain and decreasing Cymbalta dosage, and BINGO! ENLIGHTENMENT! There was no correlation with Cymbalta, but there was a 100% correlation of increased pain with my wife leaving on a trip! I still have trouble believing/understanding the connection, but my psychologist friend said it is quite likely. He called it a “strong dependency object relationship”. I’ll be seeing him frequently in the future, and will learn what that means, I suppose… He also says I’m “clinically depressed” and “clinically anxious”… (when in pain, who isn’t?)
But back to last Thursday…when I realized the correlation, the pain stopped…the ride home was pain free, as opposed to the ride into Seattle, which was quite painful. Yes, there was an instance of pain on Friday and Saturday mornings, but in both cases I simply waited for the pain to subside, which it did in 10-15 minutes. I haven’t taken an “oxy” since last Thursday before our meeting!
I’m back doing the DOCC program daily and there have been no painful episodes for five days now…the sciatic pain is essentially gone! I’ve been to the gym several times, again with no pain. So other than these severe mental problems, things are looking very positive! lol Integrating Dr. Hanscom’s DOCC concepts with traditional psychology is going to be “educational” I think.
Thank you for your help…I’m so grateful that you suggested we postpone the surgery!
Best regards,
Ray
p.s. Do you think it would be a mistake for me to attempt jogging again? I’ve run/jogged for 40 years, and thought that it might have contributed to the sciatic pain…but that doesn’t seem to be a factor now. I really miss the activity…the machines at the gym can’t compete with the deserted, sandy beach here.
p.p.s. On Dr. Hanscom’s website, there are several anecdotal stories of patient testimonies, and the relief that DOCC has brought them…I’d certainly be happy to write a brief description of my own “story” if you think it might help others…acknowledging that it’s only been a week of no pain!
My Perspective on Ray’s recovery
He was a patient who came to Seattle from a distance. He had called our clinic about six months ago. As he was experiencing severe pain down his leg he wondered if we could see him earlier. He was miserable and I was open to performing surgery relatively quickly. However, although his scans showed some bone spurs that were probably causing his pain I did not see anything new that would explain why his pain had become so uncomfortable that quickly. I gave him material to read about surgery as well as a copy of my book and website and told him to call me in a couple of days with his decision. I did not hear back from him until a few weeks ago. He had engaged in many of the concepts of the DOCC project and his pain disappeared.
But now his pain had returned more intensely than ever. It was located in the same leg and location. I repeated his MRI, saw him back, and was awaiting a phone call about when he wanted to schedule surgery. Instead I received this letter.
The “Sarno effect”
This occurrence is relatively common. We call it the “Sarno effect”. Dr. John Sarno discovered the Mind Body Syndrome in the 1960’s and 70’s. His approach was to identify the “trigger” that lit up the pathway and the problem would be solved. He was correct and it can and does occur.
Deal with any trigger
I feel that his methodology is very helpful. But the DOCC project is more generic in that it does not matter what the trigger is. Ray will definitely relapse. It is the nature of pain pathways. They are permanent and deeply imbedded. It is just important to understand that you have been triggered and then use whatever tools work for you to pop back out of the pain pathways. It is a learned skill that eventually you will become quite adept at.
Where is Nirvana??
I keep thinking that somehow I will hit a place that I will never have to descend back into these circuits. That is not reality as life does keep coming at you. One of my goals is to be easier on myself when I get tripped up.
What I have also discovered is that learning these skills is not difficult. You simply have to be open to change. Unfortunately, for many, anger blocks that possibility.

 

[Eric "Herbie" Watson]

This is another great post Dr. Hanscom.
I have learned a new word today thanks to reading this thread ( The “Sarno effect”) That's awesome. I learnt the sarno effect over a year ago now and ive been so ecstatic about it that I cant stop looking for more and more tools to add to my tool box. I as the guy above have learned about triggers and how they can send pain into any part of our mind or body.

I often give help here at Tmswiki and I usually look for a trigger to identify but often ill give advice on where to look as triggers seem to be often unconscious and unaware to the person experiencing the pain or anxiety.

Ill give a personal example from my past that illustrates how I began to notice triggers and when I did id have these Ah-ha moment with the pain significantly dropping to a 1 or 0 on the 1 to 10 pain level scale we often use.

I was getting back to my work outs after a year of being bedridden from extreme pain radiating all over my back to my feet. I also had shoulder and neck pain that only added to the anxiety of the pain. Anyhow id been doing well journaling and changing my focus and going by sarnos daily 12 reminders. I was about 2 months into my healing phase and I had this pain come back on me pretty strong.

I thought what can be bothering me emotionally. I journaled and actually wrote down an argument that id had with my niece in the journal but I was still unaware that the argument with her was the trigger. That night id had a dream of her, and in the dream I felt the pain instantly come on like a run away train. Upon awakening I knew the argument was the trigger and I also knew I had to come to grips with this issue.

I saw her that day and I didn't have any pain come back since id been aware that it was the argument that caused the trigger in my dream but I felt an over whelming sense of anxiety. I took my niece to the side and I said look, I love you and we been friends way to long to keep our distance from each other and not speak anymore. She agreed and we hugged. My anxiety instantly left and I went through the rest of my healing phase spotting triggers and acknowledging them. Id have that Ah-ha moment and move forth with another step closer in my healing journey.

This awareness of the Sarno effect and triggers has been the holy grail in my full healing as of now close to 18 months later now. Thank you so much for your
understanding of the Sarno effect and how you pay special attention to your patients and when you see their nerves are calmed and then you notice that they are having less pain. This is great to know we have a Dr. that fully understands the Sarno Effect
Bless You.