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Why I Love Treating Patients with Chronic Pain
by Dr. David Hanscom, MD
Guest Editor of Integrative Medicine


Generally speaking, doctors don’t enjoy treating patients with chronic pain. Why? Because they are historically difficult to help. As a surgeon, I find it hugely rewarding to be able to do a procedure that makes a patient’s pain go away – when I do that, the patient is happy and so am I. The problem with chronic pain, however, is that there is often no identifiable, visible, measurable cause for the pain.

Doctors are trained to act like detectives, to find the reason or source for a problem, and then to address. However, pain does not need an identifiable structural source to exist. There may once have been an injury (for instance, a soft tissue injury at a level below the sensitivity of diagnostic test) or perhaps the problem is inflammation, which is a chemical, not mechanical source.

Also, new research has shown that the brain can create pain which is identical to the pain of a physical injury. Other studies have demonstrated that our brains process an emotional insult in exactly the same way as a physical injury. Stressful life events not only can bring intense emotional reactions but also severe pain.

Mind Body Syndrome

In situations like these, pain can become something like a habit that your brain can’t break. To illustrate what I mean, remember when you learned to ride a bike as a child? You can’t “unlearn” that skill. That’s because when you learned it, your brain cells developed specific pathways that allowed it to become embedded. Those pathways, each consisting of thousands of nerve cells, are connected to and communicate with your body. This is how we learn – it happens with repetition and it happens with trauma.

Pain that develops like this is known as Mind Body Syndrome (MBS). Many (perhaps most) doctors aren’t aware of or well-versed in MBS – some don’t even believe it exists.  But when pain caused by MBS gets treated with pain medications or injections or surgery, it doesn’t go away. The patient still has pain and is left frustrated and depressed.


However, when the true cause of the pain is recognized, there are ways to address it. The brain can create new pathways that can override the pain circuits – with practice and repetition, they too can become embedded. As these new pathways become stronger and stronger, the pain fades away and eventually vanishes altogether. (This is called “neuroplasticity.” Compelling neurological research has demonstrated that even late in life the brain retains neuroplasticity – the ability to adapt, change and develop new nerve pathways in response to life events.)

For people with chronic pain, the way to reverse these pathways is to engage in programs that utilize Mind Body principles. A colleague I deeply respect, Dr. Howard Schubiner, outlines one such process in his book, Unlearn Your Pain.  My website (davidhanscommd.com) and my book, Back in Control, describe my version. The key to these and other effective programs is utilizing tools that create alternative neurological pathways.

The best part of the diagnosis of Mind Body Syndrome is that it is extremely curable! This knowledge (which is fairly recent) has dramatically changed the way I practice medicine – and that is why I have come to truly enjoy treating patients with chronic pain – because I am able to help them. If I seem a little overenthusiastic about this whole program, it’s because I am.  There is nothing more rewarding than seeing a patient without hope regain his or her life.



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About the Author

Dr. David Hanscom, MD, is an orthopedic spine surgeon at Seattle Neuroscience Specialists with Swedish Medical Center in Seattle, WA. He specializes in complex spine problems in all areas of the spine, and has expertise in adult and pediatric spinal deformities, such as scoliosis and kyphosis. Dr. Hanscom is a salvage surgeon and operates only as a last resort. He has successfully treated hundreds of patients for chronic pain with out surgery.

Website: www.drdavidhanscom.com
Back In Control: www.drdavidhanscom.com/book







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