Back in Control – A New View on Chronic Pain


On my morning commute this weekend, I was listening to National Public Radio (NPR.)  It makes the time fly by, and I heard an interesting session of The People’s Pharmacy.  The session was Show 1071 – How You Can Get Relief from Chronic Pain.

In this show, they interviewed Dr. David Hanscom, a board certified orthopedic surgeon specializing in complex spine problems.  However, he stated that he tries to discourage his patients from having spinal surgery unless it is truly needed.  In fact, he said that 90% of his patients end up not needing spinal surgery!  Dr. Hanscom has published a book called, Back in Control, which gives advice on how to deal with chronic back pain without the emphasis on pain medication and surgery.

One of Dr. David Hanscom’s patients, Mark Owens, was interviewed on the show about his experience.  Mark was thrown from a horse and experienced chronic back pain for 9 years that was not helped by surgery.  When Mark met Dr. Hanscom, Dr. Hanscom recommended that he start expressive writing.  As Dr. Hanscom explained, many patients with chronic back pain really have a change at the brain level in how the body processes pain.  When studying brain imagery, individuals with chronic pain had pain “driven” by the emotional side of the brain instead of an acute pain area.  This is known as neurophysiologic disorder.  In a way, the brain has reprogrammed to feel the painful stimuli.  In this case, fixing something at the spine would not be helpful. In fact, Dr. Hanscom reported by chronic pain can be created at the spine surgery location in 40% of patients.

According to Dr. Hanscom, this chronic pain pathway cannot “interrupted” or “relearned.”  However, it can be bypassed by using the following steps:

  1. Awareness: Become aware of the effects that disruptive pain pathways have on your body and nervous system.
  2. Detachment: Create a space between these painful stimuli and the automatic response.  For example, if your back hurts when you bend over, you might automatically tense when you have to tie your shoes.  Dr. Hanscom says that, “you have to let go in order to move forward.”
  3. Reprogramming: A large part of Dr. Hanscom’s advice revolves around cognitive behavioral therapy.  In essence, you reprogram your brain to create space between you and your thoughts.  This has been proven to be helpful in treating chronic pain and its associated anxiety.

This leads into expressive writing.  Expressive writing is when you write freely about your negative thoughts.  The more specific you are about your pain or negativity, the better the results.  Destroying these writings is necessary as it helps you to be in control of these negative thoughts, and it encourages more freedom with writing.  In general, Dr. Hanscom advises patients to write once or twice a day for 5 to 20 minutes.

Mark was willing to try expressive writing, and within a few days, he was feeling “almost 85% better.”  The benefits of expressive writing have been documented in medical literature.  Several of Dr. Hanscom’s patients get relief from this single technique.

As an upcoming physical therapist, I found this show to be particularly interesting.  We had lectures about chronic pain in physical therapy school that described the “brain level changes” seen with long term pain, and this show provided a great personal account. Physical therapy and other techniques like those that Dr. Hanscom described are less dangerous and addictive than opioid prescriptions that are typically given. In fact, recent Center of Disease Control (CDC) guidelines state that “nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.”  Hopefully, this will lead to a decrease in the opioid epidemic and an increase in patients living pain free.

Interested in more about pain theory?  I recommend the following video by Professor Lorimer Moseley.  He has a great sense of humor, and he explains pain in an easy to understand way.





Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder.  He is a fantastic physical therapist whose mission is to help physical therapists provide patient focused care without becoming overwhelmed.  Greg Todd is also known as a “social media guru,” and I have a lot of thank him for.  I highly suggest his courses, especially Smart Success PT.  In May, I plan to attend Smart Success PT Live, a business, marketing, and branding course by some of the  top PT entrepreneurs in the field.



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