Dr. David Hanscom is a trained spine surgeon and spent his career operating on patients. His life mission shifted when he recovered from his chronic pain, not through surgery but by treating the nervous system.
The History of Spine Surgery
Arun: I'm curious to hear more about your medical career in practice.
Dr. Hanscom: I trained in Minneapolis, Minnesota in 1985-86. It was considered one of the top spine fellowships in the world at the time.
About that time, my partner brought in a technology called a Steffee Plate, named after Dr. Art Steffee. Using the plate, we started doing spinal fusions for back pain.
To see if a patient was a good candidate - they would first inject dye into the disc, and if it was painful, they were scheduled to operate. Seattle started performing nine times the rate of spine surgeries than any other place.
In 1993, a paper came out that showed that the success rate of a fusion for back pain was about 22%.
Whoa. I thought it was 90%. I mean, it's a big operation, you're taking beautiful tissues and putting in hardware. I was part of that. I'm a surgeon, I thought this is the right thing to do. I felt guilty if I couldn't operate on someone.
Worldwide, there are about 1.6 million spinal fusions done a year now. There are many good reasons to do it, like trauma, tumor, and infections - those are necessary. There's not one research paper that shows that a fusion for back pain works. Not one.
So that was a moment in my career. I said, look, this is crazy.
Non-Operative Approaches
Arun: This is a truthful, and also a scary picture of what's going on today!
Dr. Hanscom: What also happened, in the early 2000s, is Dr. Brox published a paper that compared surgery to physical therapy and non-operative care, and the latter performed better for back pain. However, the last paragraph of the paper stated that even though non-operative care is more effective than surgery, it is not readily available.
My focus has been for 25 years, to take the research, and use it. So what do we know about back pain? We know that disc degeneration is normal. We know that bone spurs, herniated discs, are all normal aging spines.
Every time you place a screw into the spine, you have a chance of hitting the spinal cord or a nerve. So the complications are way higher than you can imagine. At least half of all spine surgery, I would even say 70%, should not be done. That's a lot.
Arun: If I'm a patient in pain and in that 80% for which a surgery won't work, I’m looking for another source of my pain. Can you talk more about this?
What is Chronic Pain?
Dr. Hanscom: So the data shows that chronic pain is a neurological problem.
The definition of chronic pain, in any part of the body including back pain, is that it is an embedded memory that becomes connected with more and more life experiences. The memory cannot be erased. It's like Phantom Limb and can occur at any part of the body.
It’s not imaginary, not in your head, not psychological – just how the brain and body, work.
First of all, all pain is created by your brain. You have all these centers sending signals to the brain, the brain has to say, is this is safe or not? For example, I'm not going to look into this light beside me because it's too bright. My brain is taking in all this sensory input while at the same time protecting your body.
In the same way, I'm not to put my hand on a hot stove. The nervous system is continuously interpreting our surroundings. So if there's pain that keeps coming at you, the brain says this is dangerous. Eventually, then it gets memorized. Even if the problem was structural in the first place, if you have symptoms for more than six to 12 months, the brain takes over.
Arun: I want to stress that you’re not saying it’s in someone’s head. I assume that if there’s pain, something in the body is changing? Do we understand the physiology behind this?
Dr. Hanscom: I’m a part of a workgroup of pain experts, that you're aware of, that meets twice a month to discuss this. What’s been documented in the literature over 30 years, is that all chronic diseases are both mental and physical.
For example, we have stress in life. It turns out that mental stresses and physical stresses are processed the same way in the body. What both do, and I didn't realize this until a few years ago, is fire up your immune system.
So you have these inflammatory cells called cytokines, little proteins called cytokines that are firing up your whole body. Your metabolism or rate of fuel consumption goes up, you get increased adrenaline cortisol, and inflammatory neurotransmitters in the brain. So your brain is hypersensitive and you feel pain even though you shouldn’t.
Throw in lack of sleep, fear of pain, less exercise; it's all inflammatory.
Treating the Nervous System
Dr. Hanscom: Think about your car. It’s a structure, there are no symptoms. When we turn the car on, that’s the biology of it. If the car is missing a spark plug, it’s a structural problem and of course, the car is not going to run as well.
Now let's say you have a normal car. You're driving the car down the freeway in second gear for hours and hours at a time, it's going to break down eventually. There are no structural problems, but the stress on the engine will overwhelm the capacity of the car to deal with it.
So going back to this process, I call it dynamic healing. When your circumstances overwhelm your nervous system's coping capacity, you go into fight or flight. When the fight or flight response is sustained, people get sick. The essence of chronic disease is sustained exposure to what we call threat physiology. And the essence of healing is teaching people how to go into safety because it allows the body to regenerate.
What we have learned is that if you're treating just symptoms or physiology, like a migraine headache, you’ll going to treat with medications. If one goes home to an abusive relationship, your stresses are overwhelming your coping capacity, and you're still gonna have the headache.
There are ways of increasing the resiliency of your nervous system.
Arun: What are some of those ways?
Dr. Hanscom: So the reason why I quit my practice is a couple of things. I've seen hundreds of patients go pain-free. Chronic pain is considered, unsolvable, it’s incredibly solvable. To solve a problem, you have to understand what the problem is. So medicine's gone off a structural pathway without any data.
What Dr. Les Aria has taught me is that there are ways of actually calming down your body's fight or flight response with breathwork and more, that are anti-inflammatory. They take you out of fight or flight right into safety. So a given person learns the tools in each realm to regulate your body's chemistry to minimize your time in fight or flight.
Arun: Let me ask you one more question. This is awesome. I love this. Can you share a story of a patient of yours who has been through a lot, perhaps multiple surgeries, and was able to use these methods?
Patient Stories
Dr. Hanscom: Well, let me just tell you three quick ones. The first one is the forward of my book.
His name is Dutch. He’s very open about his success stories. He had four years of back pain and was only 27 years old when I met him. He flew from the bay area to see me in Seattle. He had five surgeries, recommended a spine fusion for spondylolysis, which is considered not to be a source of pain. He was very cynical. I said, look, this is not a surgical problem. Again, he asks a question, well, what do I do? He read my book and started going through the exercises on my website at the time. Over about a year, he went pain-free.
I just talked to him a few weeks ago. He's now getting married, holding a job. He hasn't had back pain for years. He's a backpacker, an extreme athlete…zero limitations. His anxiety is down and his pain is down. He's doing just fine.
Another patient, Tom, had had 28 surgeries in 20 years. Eight of those were back surgeries. And about six years ago, he tried to commit suicide. He was on high-dose opioids, alcohol, just a complete mess.
I thought personally, after about two or three surgeries, the chance of getting better is about zero. He ran across my book and connected with the concept of how anger fires up the nervous system. Somehow he was quickly able to let go. Within a month, after 28 years, his pain-free.
Now, it's not quite that simple because there are lots of ups and downs. As you've learned the tools, I'm still working with them. But six years later, he's, pain-free, he's exercising every day. He's with his family and he asked, he says, I've never felt better in my entire life and as compared to any time in his life.
Another woman, 55 years of chronic pain. She's been pain-free for about six years. Once you understand the tools, you keep continuing to improve because you're just changing the way your brain is functioning.
Arun: What’re you working on today?
Dr. Hanscom: I have a book called “Do I Really Need Spine Surgery”. It can help someone understand if they have a surgical problem, surgical and nervous system, or nervous system problem. I’d recommend that anyone considering surgery take a look at that. I also have a website and app called the DOC Project.
Arun: Amazing. Thank you for sharing such a wealth of knowledge.
Dr. Hanscom: Thank you, Arun.
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Modern research shows that psychological and emotional elements can play a major role in chronic pain. These non-physical components can help the brain “learn” to be in pain. By training the brain, we can re-wire the body’s neural circuitry to dial down pain sensations and bring relief.