There is never a single solution for your chronic pain. There are many factors that have to be addressed and each aspect has many individualized possibilities. It can be compared to fighting a forest fire. Clearly every possible resource is utilized to extinguish one. Local brigades can extinguish most wildfires quickly if they are detected early. It is well documented in the medical literature that early intervention in high-risk patients is the one factor that will consistently improve outcomes. It also prevents a given situation from becoming high risk. Someone has to be in charge If a wildfire becomes too large a general call for help is sent out. The first fire chief to arrive on the scene is the one in charge and sets up the base of operations. He or she has to coordinate the operation. The person that must take charge of your chronic pain is you. You are unique and even if your doctor could spend hours with you assessing your situation, he or she could not really know your life in enough detail to solve your problems. You are the only one who is experiencing your life through your eyes. The essence of fighting a forest fire is assessing the situation, containing it and taking away its fuel. Extinguishing the blaze requires multiple strategies depending on the height of the flames, local terrain, weather and many other factors determine the choice of resources and strategy. For example, fire travels more quickly up a steep hillside, especially when it is dry and fanned by a strong wind. Compare that to a brush fire on flat land without wind and it is raining. That is the same approach that is effective in dealing with chronic pain. Fueling the flames Lack of sleep, adrenaline stimulated by anxiety and anger, inflammation, stiff tissues, lack of conditioning, high narcotic doses, and staying focused on every detail of your pain amongst other factors add fuel to the fire. It is not logical to think that there would be one answer that could resolve your pain. That includes surgery. In fact there is ample data that shows that performing simple surgery, such as a hernia repair, can induce chronic pain lasting up to a year 30-40% of the time. There is a 5-10% chance of it becoming permanent. Chronic pain is seldom mentioned as a complication of surgery. Operating in the presence of a fired up nervous system is risky. It is adding even more fuel to the blaze. Patients underestimate the impact of living in chronic pain and also the fact that surgery could cause it. If I told you that I had a 5-10% chance of cutting the nerve to your foot so you could not lift it up you would probably opt out of the surgery. However a foot drop is painless and much better tolerated than ongoing burning sensations down your leg. I routinely see patients who have been referred for surgery, have not slept well for over a couple of years, are experiencing severe anxiety, and are understandably angry. How do you think surgery is going to work in this scenario? It is possible to have a successful outcome but it is much lower than when these other issues are dealt with. Video: Get it Right the First Time It has been documented in hundreds of research papers that addressing the following areas have a significant impact on both surgical and non-surgical outcomes. They are: Sleep Medication management Physical conditioning Stress Life Outlook/ Goal setting DOCC Overview The DOCC process is largely self-directed and there are three parts to your healing journey: The first is to understand chronic pain. It is a neurological problem that is different than acute pain. It is sensed only in the emotional, not the pain center, of the brain. Second, all the variables relevant to your situation must be simultaneously addressed. There is never a single answer. Finally, every successful patient has taken full responsibility and taken control of his or her own care. Once a patient immerses him or herself in an organized self-directed program he or she will improve or go to pain free the vast majority of the time. The improvement also includes mental pain and anxiety will drop. Once you are no longer fighting ongoing anxiety and physical pain your energy levels will rise and creativity re-enters your life. It is always inspiring for me to witness these changes. Some people have dramatic changes within weeks and others do not hit that point for a year or two. I would estimate that most people experience significant improvements within three to six months. Deb’s journey out of pain Deb is a social worker with a lot of energy. On a given week she has at least three or four projects going and she has over 40 employees. About six years ago she developed neck pain during a period when she was under a lot of work stress. It began as tightness in her neck. She had also been in several car accidents over the years and she had some pre-existing pain pathways. It persisted and evolved into a full-blown chronic pain problem. She is quite focused and was so determined to find an answer that she did her Ph.D. thesis on chronic pain. She still could not solve it. Four years ago she attended the first Omega workshop that I put on with Dr. Fred Luskin, author of Forgive for Good, and my wife Babs, who is skilled in rhythm and movement. It was a five-day course that incorporated all of the principles of the DOCC project including play. We had 11 participants that year and most of them experienced a significant improvement in their pain during the week. She was not one of them. We kept in touch and she emailed me about 10 months later to let me know that she had gone to pain free. The combination that worked for her was the negative writing, stopping physical therapy, sleep, glucosamine and an anti-inflammatory diet. She was already aware of the role of forgiveness. I have kept in close touch with her and she is still doing well. Surgery somehow has been held out to the public and to non-surgeons that it is the definitive answer for your pain. The main indication is, “If all else has failed”. Not only is the long-term success rate for a fusion for LBP less than 30%, there is a significant complication rate including increasing the pain. Step back and look at your situation. You have a unique life with a lot of variables that can and will increase your pain. Take charge of your care and utilize all of the necessary resources to solve your mental and/or physical pain. You must take away the fuel feeding the fire.