My journey into chronic pain lasted over 15 years. Initially, I had no idea what was happening. A successful spine surgeon, I thought I was bulletproof. But, after years of practice, I began to sweat during surgery, and by 1990, I was experiencing panic attacks and a number of other symptoms, including migraines, rashes, neck pain, tinnitus, obsessive compulsive disorder, and more.
I pursued every possible avenue of treatment. I went to psychotherapy, took medications, read every self-help book I could get my hands on, and attended workshops; yet I continued to spiral downward. In 2002, I happened to pick up a book that recommended doing some simple expressive writing exercises. I did the exercises, and within two weeks I began to pull out of my tailspin. Six months later, all of my 16 symptoms had essentially disappeared.
It took another five years to sort out what had happened to me and to organize it in a way that I could share with my patients. I have now watched hundreds of patients become pain-free through a program I created called DOC (Define your Own Care). The DOC program shifts the focus from searching for the source of pain, which may not even be identifiable, to what you can do to become more functional.
The first stage of the DOC program has you slow down so you can lay a foundation for healing. In it you learn about chronic pain and begin to formulate a game plan. These are the five steps in stage 1.
Step 1: Get Clear on Your Issues
It’s crucial to confirm and understand your diagnosis, even if it requires several doctor visits. The source of your pain will either be structural, non-structural, Neurophysiologic Disorder (an imbalanced nervous system), or a combination of the three. If the source of your pain cannot be identified, that’s good news; it means that your problem is more resolvable. Once you know your diagnosis, list your symptoms and the factors affecting your pain, like sleep, stress, medications, physical conditioning, and life outlook.
Step 2: Begin Expressive Writing
I have all my patients immediately start expressive writing, a simple process backed up by more than 200 research studies. To do it, write down your thoughts by hand—both positive and negative thoughts—and then immediately destroy the paper. Be specific and write what you’re actually thinking, no matter how absurd it seems. Just get your pen onto paper. It doesn’t have to be legible or logical—even scribbling or symbols will work.
As you write, don’t analyze your thoughts—that strengthens them. When you’re done, tear up the paper. This doesn’t “get rid of” the thoughts, it just gives you the freedom to write what you want and not worry it’s going to stick around to be read again later.
The expressive writing process creates an awareness that your thoughts are just random thoughts. This gives you some distance from them and allows you to separate yourself and see that your thoughts don’t have anything to do with your reality.
Write once or twice a day for 15-30 minutes per session. If you initially find it too disturbing to focus on your negative thoughts, stop and seek guidance from a mental health professional. You can also use the auditory route. Saying thoughts allows them to travel to your brain through a different set of circuits, which achieves the same goal as writing them down.
Step 3: Practice Active Meditation
The third part of the sequence, reprogramming the nervous system, can be accomplished in thousands of ways, such as spending time with friends and loved ones, pursuing a hobby, listening to music, playing sports, etc. However, there is one core method that I feel is the starting point. I call it active meditation.
Active meditation is an abbreviated mindfulness practice that consists of simply placing your attention on sensations. There are three steps, and it just takes five to ten seconds of your time.
- Relax. I often begin by taking a deep breath or relaxing my shoulders; you can use any body part.
- Let yourself stabilize and feel the body part you relaxed for a few seconds.
- Focus on one sensation: taste, feel, sound, smell, pressure, etc. Feel the vividness of the sensation increase and stay with it for 5 to 10 seconds.
Active meditation accomplishes several things. As you relax, your body will secrete less adrenaline. By placing your attention on a sensation, your nervous system shifts off of the pain pathways. With practice, it will become more automatic. Eventually, as you use the pain pathways less, they will become weaker and the other pathways will become stronger. Practice active meditation as often as you think of it—I do it from 20-30 times a day.
Step 4: Don’t Share Your Pain
Your brain will develop wherever you place your attention. Complaining about anything will keep you stuck on unpleasant circuits. The longer you’re stuck, the stronger the circuits become, and eventually they will bury you. I was historically one of those people who could and would complain about almost anything—in detail. That included my mental and physical pain. It seemed incredibly relevant to me, and I couldn’t figure out why others were so uninterested. It was only after I began to heal that I could see how deadly it was to constantly be unhappy.
This step is simple but challenging. Start noticing how often you complain, and then just stop. Initially, you will fail frequently and be at a loss for words. You will have to make a deliberate effort to read the newspaper, watch an interesting movie, read a good book, volunteer, etc. to wake your brain back up and find new things to talk about with people. Almost everything is more interesting than your pain.
Step 5: Get Better Sleep
Sleep is the number one priority in the rehabilitation process. The only reason I put the previous steps ahead of this one is that those tools will calm the nervous system and help you sleep. None of the DOC principles will be effective if you are not getting seven or eight hours of restful sleep per night. Many people think you won’t be able to sleep until you are pain-free, but that’s not the case. In addition to working with a medical professional to properly diagnose and treat a sleep disorder, if you have one, there are a number of resources available to improve your sleep hygiene. Even in the presence of pain, you can sleep. It is the most important step on your path to healing.
Adapted from Back in Control by David Hanscom. Copyright © 2017. Used with permission.