Spine Surgeon Puts Patients Back in Control

Physician's Money Digest, Fall 2014, Volume 15, Issue 2

David Hanscom, MD, is a spine surgeon at Seattle-based Swedish Neuroscience Specialists. And though it might seem contrary to what he does for a living, Hanscom will often talk patients out of surgery. Why? Because he’s been through it himself.

“The best thing that probably ever happened to my patients was me going through my own process,” Hanscom says. He then chuckles as he adds, “Of course, I wouldn’t choose to do that again.”

Physician as patient

Hanscom’s father was a family practitioner, so it was in his blood at an early age to carry on the tradition. His first choice was orthopedics because Hanscom spent nearly 20 years—starting at the age of 14—working in heavy construction. The summer before he began medical school, he built his parent’s house. And in the summer of 1985, after completing his residency and while waiting to become a spine fellow in Minnesota, he blew out a disc while putting his son back in his crib.

Back surgery followed and, as a complication of the surgery, Hanscom contracted a post-operative infection that led to ulcers, kidney failure, and a 25-pound weight loss. The experience changed his whole perspective on spine surgery, and how he viewed people with back pain.

“As a resident, I could never understand why people would complain so much,” Hanscom recalls. “I just couldn’t understand how bad it would be. But [the back injury] still might be the worst experience of my entire life. Six months of not sleeping, severe pain, and not being able to do my job. I just couldn’t imagine people spending their entire life like that.”

As a result, Hanscom began devoting a significant part of his practice to performing surgery on patients who had multiple prior spine surgeries. But he didn’t stop there.

New ways of thinking

Hanscom is the founder of the DOCC Project (Defined, Organized, Comprehensive Care). It’s a structured rehabilitation protocol for chronic pain that includes improving sleep, managing stress, engaging in long-term conditioning, and, perhaps most important, educating patients to regain control of their decision making.

At the core of the protocol is Hanscom’s philosophy that all chronic pain can be re-routed and un-memorized.

“You have to use different tools,” Hanscom explains. “What you’re doing is you’re simply shifting other pain pathways into non-pain pathways. In other words, you can’t fix pain pathways; you can’t solve them. The harder you try to fix them, in some ways the worse it gets, because the pain pathways are still running the show. Just like riding a bicycle, you actually cannot relearn those pathways. I know some scientists say you can actually change pathways; I think that’s debatable. What you’re really trying to do is create alternative pathways around the old pathways.”

Hanscom’s book on the subject, Back in Control, provides those who suffer from chronic back pain with a roadmap to pain relief. And, perhaps ironically, writing is the foundation to the entire process. Why writing? Hanscom believes that the first step to chronic pain relief is to gain an understanding of the pain.

“I’ve not seen one patient get better without some form of the writing exercise, and that would include myself,” Hanscom says. “You have to create an awareness of the negative thoughts around the pain. With the negative writing you’re separating from those thoughts. You’re creating awareness and detachment in one step.”

Pausing the experience

After the writing is the re-programming process, which can be acupuncture, hypnosis, mindless meditations—the creation of a positive substitution, Hanscom says. And that positive substitution will be different things for each individual. It could be as simple as having a good cup of coffee.

“Pause of experience is critical as a substitution power,” he says. “Your substitution is a pause from a negative pathway. But you have to become aware of the negative pathway. If there’s someone who upsets you, you get those thoughts written down. And the positive substitution might be going to see a movie, or whatever.”

In other words, change the pathway to help manage the stress. And one of the best re-programming tools, Hanscom says, is calming down and relaxing. It’s a process he teaches his spine fellows and patients. He recommends sitting back in a chair, taking a breath, and letting go. Feel your back against the chair, and stabilize.

“When you calm down, you actually raise the pain threshold,” Hanscom says. “In other words, your body is firing impulses to the brain all the time. As you calm down the nervous system, you increase the pain threshold. It’s not a matter of living with the pain; the pain really does disappear.”

He explains his process of shifting the pathways, instead of attempting to fix them, as neuroplasticity—stimulating the brain to grow new, more pleasurable pathways.

“Every part of your body is designed to survive,” he says. “And your nervous system was designed to be hooked up to all these survival tools; 85% to 90% of your brain goes into survival mode. Over your lifetime, 90% of your impulses are going to the survival part of your brain and 10% are going to the having-a-good-time part of the brain. Your survival part gets way over-developed. So what happens is you’re simply shifting your brain by choice into the more pleasurable pathways, and letting those grow, and then the others are not used quite as much.”

Very rewarding

Hanscom says that the most rewarding part of the work he does, the true end goal, is not necessarily helping patients get rid of their pain, but seeing their lives transformed.

“When my surgical patients calm down their nervous systems first, the outcomes are phenomenal,” he says. “Instead of being part of the disability problem, we see nerves come back together; families reunite; people get their jobs back; and they thrive. It’s so incredibly rewarding, I can’t put it into words.”