“On Fire” I came out of my spine surgical training with zeal in 1986. Surgery was the definitive solution. By definition if a patient reached my office I felt compelled to do something and felt badly if I could not. I had no idea that the nervous system had so much say over the final experience of pain. Back then Seattle had a very high fusion rate for low back pain and I was right in the middle of it. I was regularly frustrated in that in spite of obtaining a solid fusion my patients would still be doing poorly. Additionally no one could show me solid data that I was making correct treatment decisions. In 1993 a paper describing the results in Washington State injured workers showed a 15% return-to-work rate one year after a fusion for LBP. I also saw many spines breaking down around these fusions. At that point I quit doing fusions for back pain but I also did not have any good alternatives. Burnout Around 1995 I sank into a severe burnout manifested by uncontrollable anxiety that spiraled into a severe depression. I barely survived it. Although I had tried every possible treatment what pulled my out of this nightmare was a book “Feeling Good” by David Burns. Around 2000 I began to share this book with my patients as well as addressing sleep. Patients began to feel better but I had no idea why. Mind Body Syndrome Ten years later I now understand that I had been inadvertently treating the Mind Body Syndrome. I had heard of it in the 1980’s but had ignored it. It is a real and treatable diagnosis. I have now seen hundreds of patients take control of their care and experience a pain free life. As a surgeon I am continually fascinated and challenged about what set of tools a given patient uses to escape their prison of pain. I also had 16 of my own Mind Body symptoms disappear including my extreme anxiety, burning feet, chronic mid-thoracic back pain, insomnia, and migraine headaches. This book is the story about my journey out of a deep abyss as I shared and learned from my patients. Burnout and Chronic Pain are Similar My burnout was precipitated by suppressed anxiety driven by the ongoing frustration of being a perfectionist. It turns out that chronic pain also is a huge stress that causes anxiety and is driven by the frustration caused by being trapped it. The same tools I used to save myself were the ones that are effective in treating chronic pain. Pain Pathways are Permanent Chronic pain is neurological issue and not a psychological problem. It is a “programming” process. Just like an artist, athlete, or musician pain lays down reproducible pathways with repetition chronic pain pathways are created in a similar manner. There is a critical difference in that pain pathways hit the brain much faster and are always linked with anxiety and anger. Once a neurological circuit is created it is permanent. Is it possible to unlearn to ride a bicycle? A Framework of Care Back in Control provides you a framework around pain so that you can organize your thinking and treatment. It allows you to address ALL of the variables that affect your perception of pain. You can then take advantage of a newly discovered phenomenon called “neuroplasticity”. Neuroplasticity It is now known that the brain can grow new nerve cells at any age. These methods will allow you to create alternate pathways around your established pain circuits. You are able to shift your nervous system on to a new track. At some threshold the pain dramatically will diminish or disappear. Each person’s experience is unique. With full commitment a successful outcome is not just possible it is probable. Many other Mind Body symptoms often dramatically improve. You also are now completely in charge of your care. When Your Surgeon Says, “No”, Listen!! This book is written by an experienced surgeon dealing with extremely challenging spines. It is still my first instinct to choose surgery as the definitive solution. I now feel that most initial spine surgery never should be performed—especially for pain. Welcome to your new nervous system and renewed shot at a full life.