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Browse published articles attributed to David Hanscom, with full-archive search.
Debbie is a 45 year old woman who I have been working with for about four years. She was diagnosed with a severe bipolar disorder at age twelve.r
There is an intense relationship between anxiety and anger. Understanding this interaction is perhaps one of the most important concepts that will have a major impact in calming down your nervous system. Anxiety and Anger are universal. Few human beings have seemed to rise above them. They are both survival emotions. Anxiety represents a feeling of vulnerability and helplessness. At the deepest level of our existence we are hard-wired to avoid this emotion at all costs.
Chronic pain involves a web of variables that can be complex, but often patients don't want a complicated explanation for their pain. The pain is so severe, and so difficult to live with, that they just want to hear a simple root cause. They are often stuck on the idea that their pain is caused entirely by a physical injury. When presented with any alte ative concepts, they can become very angry, demanding, and sometimes will storm out of my office. Others are more polite but really are not open to any new ideas.
Pain is a multi-faceted experience. For a given pain problem ALL of the factors that affect the perception of pain must be successfully addressed. In regards to low back pain there are three categories of issues: 1) potential structural problems 2) the soft tissues supporting the spine 3) the central nervous where the pain impulses are received and interpreted.
In 1999 I moved to Sun Valley, Idaho to be close to my son who was seriously competing as a mogul skier. I went from a large group and a huge hospital in Seattle to a small practice and a community hospital.
The Source of the Pain—“Pain Generator” It is an almost universally held concept among surgeons and patients that a specific structural lesion is usually the source of pain. If that lesion can be identified and repaired, the pain will resolve. This seems plausible. It seems likely in light of the intensity of back pain that a diagnostic test ought to be able to identify the source of intense pain and point to a solution.
One of the more puzzling situations I have run into frequently is that I see patients who have experienced significant disabling chronic pain for many years. Often they have had multiple failed spine surgeries. Yet on my spine intake questionnaire they rate themselves as a zero on a scale from zero to ten in regards to anxiety, depression, and anger. Upon further almost intrusive questioning from me they adamantly will stick it. They are really just fine except for the pain.r
Why “discogenic pain” is a Non-structural Diagnosis The problem with calling this a structural diagnosis is that it is not humanly possible to tell which disc is the painful disc at a specific point in time. It is a reasonable supposition that if a person ruptures and L4-5 disc, that the preceding episodes of axial low back pain were probably from that disc. However, during that period of episodic low back pain, we don’t have the tools to accurately figure it out.
I am a surgeon. I think like a surgeon. I am intent on finding a structural problem I can surgically correct and relieve my patient's suffering. I feel a deep sense of satisfaction and I am my patients' hero. It is a privilege to be able to offer that service to my community.
In 1998 I moved to Sun Valley, Idaho for personal reasons. I became the sole proprietor of a one-physician spine surgery practice in 2001. I did not have the rehab physicians to rely on. I made a commitment that I would take care of all the patients that walked through my door. It did not matter whether the problem was acute or chronic, surgical or non-surgical. I began to utilize the concepts I had learned from the rehab physicians. I was very pro-active and aggressive in implementing and following up on treatment plans.
When your brain is hammered week after week, month after month, and sometimes year after year with the same pain impulses, it becomes very efficient in processing them. It takes less of an impulse from your back to elicit the same response in the brain. Or looked at differently the same impulse causes more neurons in the brain to fire. It is this process that causes patients to complain that their pain is getting much worse in spite of no additional trauma.
The DOCC program is a framework that breaks down the pain experience into its various component parts. This framework enables the providers and patients to communicate much more clearly, and effectively so as to develop a partnership to solve the problem. With musculoskeletal pain, there are three components to the problem: - Possible anatomic structural problems that need definition - The soft tissues such as ligaments, discs, fascia, etc. - The central nervous system
Jean was a middle-aged business owner who had come to me for a second opinion. I had her fill out an extensive spine pain questionnaire, which includes many psychosocial questions in addition to a history and diagram of the pain. Jean was very healthy and normally extremely physically active. Her low back pain started in the summer of 2005 after a lifting injury. The pain was fairly constant and was located throughout most of her back. She was still functioning at a fairly high level in spite of the pain.
It has been my personal observation that most of us don’t have a clear idea regarding how to manage our stress. My tools from early high school were positive thinking and just being tough. I felt do whatever I set out to do and could get through any difficult circumstance. I would not allow myself to get angry. I did not even know what the emotion of anxiety was. No one could hurt me.
I had started out my working life as a carpenter at age fifteen. I worked every summer and vacation doing residential construction. I did everything from heavy concrete slab work to finish interior work. The summer before medical school I built a 5,000 square foot house for my parents. I was energetic and a hard worker. I was also young and tough. I could lift and carry anything. I had a strong back and loved to show it off. I heard endless admonitions from my fellow workers and supervisors to be careful of my back. What did they know?
I had started my practice in Seattle in 1986. I was for the first time feeling pretty beat up from my spine training and overwhelmed. I felt well trained and still had a rather high opinion of myself, but I was tired. It also quickly became clear that low back pain was much more complicated tha I had thought. Patients with low back pain made up the majority of my practice. I also had no insight into the nature of chronic pain with its devastating effects.
It is an almost universally held concept among surgeons and patients that a specific structural lesion is usually the source of pain. If that lesion can be identified and repaired, the pain will resolve. This seems plausible. It seems likely in light of the intensity of back pain that a diagnostic test ought to be able to identify the source ofrnintense pain and point to a solution. During my first seven years of practice it was my assumption that if a patient had experienced low back pain for six months then it was my role to simply find the anatomicr