Chronic pain, spine surgery and calming the nervous system

Anyway, most pain in the body cannot see it from a test. Does that mean everybody's faking it? No. Remember, pain is an output. It's not an input. The way we survive on this planet is that our eyes, ears, taste, smell, all those things are bringing in sensations. Our body's interpreting those to say safe or unsafe. Of course, pain is one of those sensations. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey, guys. It's your host, Dr. Sebastian Gonzales for the Restoring Human Movement podcast.

Thanks for joining the Movement Movement. Today, we're going to have on a guest. This is Dr. David Hanscom. He is an orthopedic surgeon, so he's going to be the, I think, second orthopedic surgeon I've had on today, and he's going to have an interesting take on some of the surgical interventions, at least for spines, and some of the treatment options you can do that wouldn't be what you typically think if you're going to stereotype from an orthopedic. And so, it's going to be interesting to have him on. Stay tuned for it. If this is your first time in the podcast, thank you for joining us. This is going to be about an hour's worth of conversation.

And typically, this podcast is targeted at improving us as a, not just clinician, but also as patients to kind of understand what's going on with our body and, like, what's going on with our care. And so, I like to imagine it as, like, say, I'm in a bar with a friend who's a clinician. We have a friend who's a, let's go with truck driver today, who's a truck driver. And so, when we're talking about certain things, we're saying, hey, what's that, you know? And so, I like to clarify some of the stuff to make sure that everyone really understands because, really, this whole thing's about getting people better and getting people to feel better.

And so, that is the goal of the podcast and to improve the healthcare profession as an overall goal. If you have not heard the other podcasts, by the way, this is up into, like, I know iTunes doesn't allow numbers anymore, but we're up into, like, 145, 150, something like that. I forget exactly which one this is going to be. But for the most part, there's some really good stuff way back in the archives, even down into the 60s and 40s. And so, go back there, read the titles, and figure out what interests you, okay? Some of these podcasts are directed at mainly clinicians to improve our abilities.

The other ones are intended as learning tools, teaching tools, patient education. So, I want you to share them with your patients. Now, also, if this is your first time in the podcast, I like to share a little bit about my own life just because I'm your host, and I want you to know who the heck I am. And so, I usually do that in short format story. And so, we'll get into that first, and then we'll go straight into the interview. All right. So, if you already know, if you've read my book, you probably know that I have a rabbit, a bunny. His name is Ozzy. I used to have two bunnies, though. It was Kaya.

And so, these bunnies were buddies. And so, I like to do what I call, it was called the ultimate bunny experience. And so, I would lay down in the bunny area. And the bunnies had this area that was, like, about the size of, like I say, a 10 by 10. It was kind of like, it was the dining room, really. And so, it was gated off to make sure that they weren't going to take off and go about the house and tear up cords and whatnot. And by the way, you know that someone has a bunny when they have a nip in their cord of their computer. Cord, by the way. So, I do. It's surrounded by black tape. So, don't take my cord.

I know what cord is my cord. And so, anyways, I lay down. I have what I call the ultimate bunny experience. And this is where you lay all the pellets all over your chest and stuff. The bunnies jump up on you and just start eating. And so, you get this unique view of their face when you're chewing. And so, if you haven't been under a bunny when it's eating, it looks like it's always frowning. It's kind of cool. And you see this little mouth going, yum, yum, yum, yum, yum, yum. So, if you have a friend who has a bunny, try the ultimate bunny experience. Multiple bunnies are preferred. All right.

Now, we're going to get on to the content. All right, everyone. Welcome on Dr. David Hanscombe. Hanscombe. Yes. Okay. I've been known throughout all these podcasts to mispronounce everybody's last name no matter how easy it is. Got it. So, I want to welcome you on. So, just to frame everything today, I'll have you tell everyone about yourself. But for the most part, the listeners are healthcare providers. Usually, I like to call them people in the trenches. So, the rehab professional, the movement people. Right. So, let's hear about yourself. Hi. Well, I'm excited about being on the podcast. And my whole intention of what I'm doing, I'll explain how I got there, is to let the world know, especially healthcare providers, because they have such an impact, that chronic pain is actually a curable problem.

It's not to be managed. And the data shows only about 20% of physicians are comfortable treating chronic pain. Less than 1% enjoy it. I've given talks to a chiropractor, it's a physical therapist. And it's the same problem everywhere I go is that patients in chronic pain simply wear providers out. Is that a fair statement? I think it's pretty fair. Yeah. And then we know, in spite of our higher technology and more interventions, that disability is going up, chronic pain is going up. So, we're actually not solving the problem. The key issue here is that I was in chronic pain myself and it is a solvable problem.

The neuroscience research the last five years has clearly given us the answers about what to do and how to do it. And it's disturbingly simple about how to solve the problem. And I think the chiropractor is one of the, well, and the trainers, physical therapists, I think all of us have the capacity to solve the problem because it's mostly patient directed and we've become the quarterbacks, coaches, and cheerleaders. But basically, what happened to me personally, I did my spine failure it was by 1985, 86. I came out on fire to insert it on everybody that walked through my door. I was very aggressive about it.

I thought I was highly trained. I thought it was the right thing to do. I actually felt guilty if I couldn't find a reason to do surgery. But in 1993, the data came out that the success rate of a spine fusion for back pain was about 25%. So, I just stopped. I thought it was like 90, 95%. And I would say, looking backwards about, I looked my patients up and about half of them were doing well, but it wasn't nearly the 90%. Especially in light of the magnitude of the operation, which was a significant complication rate. In 1993, I simply quit doing that operation for back pain, but I didn't know what to do.

Then from about 1988 to 2003, I dove into chronic pain myself at a level I can't even describe. And I developed severe chronic pain for about 15 years. The last eight of those were absolutely intolerable. One of the manifestations of chronic pain that we'll discuss in a second is anxiety and went from being this major fearless spine surgeon to being crippled with extreme anxiety. It turns out anxiety is not a psychological issue. It's simply a sensation generated by your body stress chemicals. And that same adrenaline that took me right up the hill to a top spine fellowship fellowship took me right down the other side.

But nobody could tell me what was going on. And what happened in 2003, really by luck, I inadvertently started these writing exercises prescribed by an author, David Burns. And within two weeks, things started to shift. By six weeks, things have shifted a lot. And by six months, I was pain-free. I was fine. Here are the layers to that story, of course. But the book I wrote called Back in Control is Surgeon's Rome About a Chronic Pain. It was first published in 2012. Then the second edition was published in 2016. The second edition is much more neuroscience-based, makes a lot more sense. But we've had hundreds of patients go to pain-free with about a 90% self-directed process.

There's three parts to getting better. First part is simply understanding the problem. The reason why so many practitioners are uncomfortable treating chronic pain is we're not approaching it from a neuroscience standpoint. Medicine in general has become very focused on a structural source for every sort of pain. And if you can't find a structural source, then, quote, can't find it, medically unexplained symptoms, patient must be faking it, whatever. The reality is it's based on the body's physiology and body's chemistry. That's what has a profound effect on your body's symptoms. It's not the structure.

But we've been taking down the structural road. We try all these structural interventions and in isolation they simply don't work. The current definition of chronic pain is that it is an embedded memory that becomes connected with more and more life experiences and the memory can't be erased. It's a neurological problem. It's a memorized neurological problem and the memory can't be erased. We start doing these structural interventions for a neurological problem with phantom limb pain being the classic one. Over half the patients with, I'm sorry, 90% of patients with amputations have phantom symptoms like the leg is still there.

55% not only feel the limb like it's still there, they feel the same pain. Why is that? There's no leg or arm. But that's a huge clue as to the nature of chronic pain. Anyway, we keep persisting in providing these structural solutions to a neurological problem. It can't work and it doesn't work. And that's why less than 1% of providers really enjoy treating chronic pain because they're treating it the wrong way. So when you kind of realized that and you were still doing surgeries, what kind of decision did you have to make there because your job was to fix something structural, right? Right. So at that point, did you go into creating that book and you stopped surgery altogether or did you just continue going, you know?

Well, I started to refine my indications and I'm actually writing a new book that will be out this fall called Do You Really Need Spine Surgery? A Surgeon's Surprising Advice. And the bottom line is that in any realm, if you can't see the problem, you can't really fix it. If you take your car to the shop and you don't know what the problem is and the mechanic starts doing random interventions, probably not going to work, right? And if your body is if you see a bone spur that pinches a nerve with identical symptoms, and the chiropractors by the way are very good at picking this up, if you have a radiculopathy with say an L45 disc L5 radiculopathy and you take that pressure off the nerve root, surgery works almost 100% of the time.

Very reliable. But if you don't know where the pain is coming from, for instance, with back pain specifically, we know very clearly that disc degeneration has been shown not to cause back pain, right? Bulging disc, degenerated disc, bone spurs, facet arthropathy, none of those things have been shown to be connected or a cause of back pain. End of story. But yet right now it's the most common reason we do surgery for back pain is because of MRI scan disc degeneration. In fact, the radiology reports now say that disc degeneration is considered a normal finding must be taken into consideration when you make decisions about interventions.

It's right there on every x-ray report now. Yet the data also shows that only 10% of surgeons are addressing the risk factors that affect pain before they do the operation. The problem is you can do a spine fusion for back pain which again has less than a 30% success rate. As you know, you've created scar tissue, bone, rods. You're taking this beautiful structure and turning into massive scar tissue. It doesn't really logically make sense and it doesn't work and then it makes things worse. There's other data that shows that if you don't address the risk factors for poor outcomes which is sleep, stress, family situations, catastrophizing, fear avoidance, all these things have been documented in hundreds of research papers to be a factor in outcomes, it's been shown if you operate in the presence of untreated chronic pain that you can induce chronic pain at the new surgical site up to 40% of the time.

If you have chronic back pain and undergo a hernia repair you can cause pain at the hernia site up to 40% of the time. Now this is a simple operation, very low complication rate, usually no pain, and 5% to 10% of the time it can become permanent. Now if I had a neurological complication rate of 10% or 5%, I wouldn't be in business, right? And people don't talk about chronic pain as a complication of surgery. Remember that chronic back pain has now caused hernia site to become chronically painful. That doesn't make any sense, right? So I'm just kind of curious with, this is my observation with some patients is that when they feel pain, whether acute or chronic, they think something's wrong or broken.

You know, they go towards the structural thought. Right. So if they continue to ask, like, so we even kind of say there's certain types of therapies still in our clinics because people keep asking for the darn things, right? It's not because we want to do them or think they're useful, it's just that people keep asking for them. And so as long as people keep asking for surgery, do you think is, I'm guessing your mission is to stop the madness of doing unnecessary surgeries. Does that sound fair? How do you stop this? Well, the first thing is to change the conversation. Right now, structural problems are rarely the cause of pain, which even become quite apparent, which is really unexpected that even structural problems get better without surgery.

So the bone spurs cause an alpha radiculopathy, what we found is that I have over 100 patients now as we calm down the nervous system, pain went away, they canceled their surgeries. These are with very tight spinal stenosis. If a patient is fixated on having surgery, I have found out unfortunately, I can rarely have a rational conversation with them because part of the disease are these spinning neurological circuits. I call it phantom brain pain. One of the thought patterns is there must be something wrong, there must be something wrong. Well, there is, but it's not a structural source. What's happened is that your brain is literally short-circuited you get these spinning circuits that are impenetrable.

That block to conversation is actually part of the disease. That makes sense. I've seen some of those. I've learned that if I engage in that conversation, that's where I can talk to providers about how to avoid burnout with these patients. It's not a rational conversation. It's not worth talking to them about that. And you just move on to other things. Let me go into the alternative of what actually works in chronic pain. Remember, I said three things. One is awareness of the problem. In other words, understanding your problem. Can you identify the source or not identify the source? Probably at least 85% of pain comes from parts of the body that you can't see on a test.

I mean, tendonitis, you can't see that on a test, right? Anyway, most pain in the body cannot see it from a test. Does that mean everybody's faking it? No. Remember, pain is an output. It's not an input. The way we survive on this planet is that our eyes, ears, taste, smell, all those things are bringing in sensations. Our body is interpreting those to say, safe or unsafe. Of course, pain is one of those sensations. When you look at a bright light, your pupils constrict automatically, or you don't look at the bright light. You avoid bad smells because they're potentially dangerous. The way the human organism has survived is we're processing sensory input every second.

Then it's guiding your behavior, your brain's guiding your behavior to remain in a safe zone. The species of Homo sapiens that didn't pay attention to those cues didn't survive. That's why you have such a finely tuned system that keeps us alive. The way this works is you have a physical threat that comes into your nervous system, which we call the junction box. Your brain's processing this every millisecond. heart. If you're threatened, your body secretes adrenaline, cortisol, histamines, and endorphins all at once and other stress chemicals, you're on high alert. That allows you to survive. The feeling generated by the stress chemicals is anxiety.

Anxiety is the result of your sensory input. It's not the cause. The reason this is so critical is this sensation of anxiety is just a sensation generated by the body's elevated stress chemicals. It is not a psychological issue. It's a million times stronger than the conscious brain. It's an unconscious survival response. It's a million times stronger than the conscious brain. It's not subject to rational interventions. How would you alter or improve the person's perception of those inputs to change that output? That's the key to the whole process is that you learn to regulate your body's chemistry.

Picture your body full of oxytocin, the love drug, dopamine, the reward drug, serotonin, antidepressant, the GABA drugs, which are similar to Valium. That's a pretty sweet chemical bath, right? When you feel relaxed, so that set of chemicals generates a sensation of relaxation. Again, relaxation is that sensation created by the body's relaxation chemicals. Okay? Okay. So the way you solve anxiety is you decrease the body's stress chemicals. Okay. Okay? And there's a bunch of ways to do that. And the thing that, so there's one huge factor here that humans have compared to other living creatures is that we have consciousness.

We have language and words. And it's been found out that the emotional pain or language or words go to the same part of the brain as a physical threat. So mental threat and physical threat are process, same part of the brain, same chemical reaction. But guess what? Humans can't escape their thoughts. I think it's pretty clear that the basis for chronic pain is this inability to escape these stress chemicals because of the relentless assault of your thoughts and your nervous system. So you can suffer with them, which we do. What got me in trouble is I suppressed them. I was a master at suppressing thoughts.

Now when you suppress thoughts and emotions, your body chemistry goes way up. In other words, when you try not to think about something, you think about it more. What it does, if you successfully suppress that feeling of anxiety, something else happens. You get another physical symptom. So these thoughts generate stress chemicals that translate into physical symptoms. In other words, there's over 30 physical symptoms that are generated by elevated levels of stress chemicals. I had 17 of them at the same time. I had migraine headaches, ringing in my ears, back pain, neck pain, I had burning in my feet, I had stomach issues.

So what happens, these chemicals affect every organ differently. So for instance, with migraines, the adrenaline constricts the blood supply to the brain. When you relax, it expands, bam, a migraine. The stress chemicals double the nerve conduction. So you start feeling pain where you ordinarily wouldn't feel pain. For instance, tinnitus ringing in the ears, which is an incredibly annoying symptom. I had it for over 20 years. It's gone. But it's because the nerve conduction has been doubled because of these chronic stress hormones. I used to think I was an adrenaline junkie. I thought adrenaline was great.

But what would happen, what I didn't realize, but I didn't feel anxiety until one day, driving across a bridge here in Seattle, I went from no anxiety, literally no anxiety, to panic attacks in one day. Right. And from that point on, it was a disaster. I mean, it took me 15 years of trying to find a solution before things calmed down. And I found the solution by accident. Nobody in the medical profession could tell me what was going on. There's now a growing group of people, both in the physicians, chiropractors, physical therapists are really quite ahead of this game. look at the neuroscience of chronic pain, but the traditional medical approach is that you manage it, you don't solve it.

Well, again, to solve it, you have to understand the problem. So I've had hundreds of patients literally go to pain free. And what happens, there's two ways of decreasing body stress chemical. Remember, anxiety is a sensation generated by body stress chemicals. The way you solve anxiety is you decrease the stress chemicals. There's two ways, two categories of doing that. One of them is directly decreasing it with exercise better sleep, mindfulness meditation, relaxation exercises. All those decrease your body's stress chemicals and you feel better. But more importantly is you change the reactivity of your nervous system.

In other words, if you're threatened, either physically or mentally, instead of having that automatic survival response, you make a choice of response. And what happens is you decrease your activity of the nervous system. It's a learned skill with repetition. You actually induce your brain to change structure. We call it neuroplasticity. It's like learning a new language. So with that, say we have, say a known threat, like someone's throwing a softball at your face kind of thing. We know it's coming. And you can make the choice of to move or not move or confront it. What would we do if we don't know, how do you identify the threat if the threat is kind of like a subconscious unknown threat?

You know what I mean? Well, that's where the awareness comes into play. And that's where the process is sort of a lifetime process is that the whole thing is that you become aware that you're stressed. In other words, your stress chemicals are up and you feel anxious. what you do, it doesn't matter where the threat is coming from. And again, a lot of times with the mental threats, we have these racing thoughts, obsessive thoughts, we're angry at something, and you all know you've laid there in bed at night being really angry at somebody. Guess what? Your heart's racing, you're a little bit sweaty, you're not going to fall asleep, right?

Okay, those are physical responses to a mental input. Again, the mental threat translates into physiological changes in the body, which creates physical symptoms. That is not psychological. It kind of reminds me of with, I know some people have done like a mind space app kind of thing where once they recognize, they go to it and they spend their five minutes or whatever it is. Right. So they have to recognize that it's there. Correct. But having a conversation with these people is not always logical. So how do we intervene or help them find that they need to do something, you know what I mean?

Well, believe it or not, solving the stress is not the solution. Okay. It becomes stressful avoiding stress. So again, you're training your body, I call it the eye of the storm, is that you're training your body to be less reactive to whatever stress there is. Once you train your body to do this, you're sort of free. I mean, life's stressful, your challenges are stressful, and if you're avoiding stress because you don't like, so remember, stress isn't the problem, it's the body's chemical reaction. You're really training your body to be less reactive, and mindspace, by the way, is a good tool to do this, but a lot of things you can't solve.

And why I call it the eye of the storm is that the metaphor is that with a hurricane, you get these swirling winds going hundreds of miles an hour or 150 miles an hour, and the center is calm, and the wind represents your racing thoughts, and you can't control a hurricane, you're not going to control your racing thoughts, or the wind can represent your circumstances, most of which you can control, and we spend a lot of energy trying to control our thoughts, can try and control our circumstances so we can be peaceful. The odds of having everything in your life lined up so perfectly that you have no stress is almost zero, it is zero, and the key is you use these tools to disconnect from the, as you disconnect from the stimulus, you can come to the center and stay there.

Pull back into it, you pull back in again. It's a learned skill, because you'll always be triggered, anytime you're anxious or frustrated, I mean something in the present, reminded you of a threat in the past, bam, you have a body chemical reaction. What you're doing is realizing both intellectually, but also emotionally, that this current circumstance is not your mother, it's not the bully, it's what it is. If you have somebody who's very close physical semblance to that bully you had in fourth grade, what's your body going to do? Your brain just connects it to, and bam, that's how it works. What you realize, again, Dr. Burns' book called Feeling Good, it talks about the cognitive distortions we all have, like should thinking, labeling, emotional reasoning, etc.

He lists 10 categories of cognitive distortions that create an unpleasant response in our body. So the neuroplasticity is a combination of awareness, separation, and redirecting. And the way we start the process, by the way, it's outlined in my book, and what pulled me out of this tailspin was called expressive writing. Have you heard of this before? I feel like storytelling or creative writing? Nope. Expressive journaling. Just simply writing your thoughts down and turn them up. Oh, like turn them up as in go extreme with them? Anything. Okay. So remember, you can't escape your thoughts, right?

We suffer, suppress, or mask them. And masking actually works to some degree, workaholic, some type of addiction, whatever. But while you're doing the masking behavior, it actually works a little bit. But obviously, the big picture is not a viable solution. You can't control your thoughts, but you can separate from them or disengage from them. And what you do is that I do this every day now. It's what actually broke me out of my 15-year tailspin. It's always a starting point for my patients, is that you write any thoughts on paper, positive or negative. Most of the research, by the way, has been done on negative writing.

But any thoughts, rational, irrational, bizarre, delusional, disgusting, whatever thoughts there are, they're just thoughts. And what you do, the thoughts on the table, you're a little bit of a space away from it. That space is now connected with vision and feel, which is part of the unconscious brain. And you tear them up for two reasons. One of them is right with absolute freedom. Turns out it can be positive or negative writing, doesn't matter. The second thing is to not analyze them, because they're just thoughts. If you want to pay attention to these things, you're actually reinforcing them, right?

So what you're trying to do, again, going back to how do you decrease anxiety, by the way, the mental pain and physical pain, the mental pain is actually the worst pain than the physical pain, but the way you decrease anxiety is decrease the stress chemicals, again, directly through mindfulness meditation, or you're decreasing your activity in the brain. What the writing does is that you're doing neuroplasticity, you're actually stimulating your brain to change structure, which is awareness, separation, redirecting. What the writing does, you have an awareness of separation in one move. If you have a little bit of a space, then you redirect.

And so the simplest redirection maneuver is change to sensory input. So instead of being erasing thoughts, just feel where you're sitting for a second, just drop your shoulders, feel where you're sitting, take a little bit of a breath, that's it. You just change sensations. You can taste your food, feel the breeze, whatever it is. I just heard a car door slam out there. Do you have any sounds in your studio? Yeah, there's a thing on the wall behind me there. I think it's the timer for the light outside. A little click, click, click, click, click. Can you listen to it for a second? I hear it. Okay, there you go.

So instead of thoughts, so thoughts are one of the sensory inputs that creates this reaction. But, you know, and again, from a chiropractic standpoint, you know, just drop your shoulders. And remember when your mind is racing, your muscles are going to be tight, right? Probably, high chance. And what you're doing is you drop your shoulders, drop your back, just feel where you're sitting. What you've done, you've now reversed the flow. In other words, you've flooded your brain with a different sensation. Instead of your brain being flooded with tight muscles, why you've now used the relaxation sensation to flood your brain out with that sensation as opposed to the racing thoughts.

I call it active meditation. I'm a surgeon. I move 100 miles an hour. I don't really have time to meditate. I think it's a great idea. But I like the active meditation because it's real time and just done. Again, feel where you're sitting for a second. We actually do this during surgery. We actually do, we go to, anytime we get a little bit frustrated, we just go to light touch and feel our instruments. We've cut a complication rate down by about 80% just by doing myofas based surgery. So would something like say barefoot walking or something for afer and input, would that fall into this category here too?

Absolutely. Yeah. But I want to go back a little bit. As far as solving chronic pain, I wrote the book Back in Control, A Surgeon's Roadmap About a Chronic Pain. It gives you the context for doing what you're doing. There's a website called backincontrol.com which is the action plan of the book. There's four stages. What I'm taking you right now is through stage one. Stage one is simply learning. So there's five steps. First step is learn about pain. The second is called expressive writing which we just described. Nothing really changes until you start the expressive writing. Again, it's not the solution.

It's awareness separation when you move. The solution comes in reprogramming. So active meditation is one of many, many tools that allows you to redirect your nervous system. So if you're meditating to solve your pain, the pain is still running in the show. Right? Okay. You have to separate first, then redirect. It's like directing a river into a different channel as you put more more effort into the new channel, your brain starts to change. Your brain physically changes every millisecond. The metaphor I like to use is that of learning a new language, let's say you want to learn French. You go to classes, you do repetition, say in five years you can now speak fluent French, what happened to your brain?

Yeah, I probably dream in French. Right. Something changed, right? But your nervous system has now changed so you can speak French. Right? Right. That's a neuroplasticity. Yeah, something physically changed to allow you to learn a new skill. What you didn't do, you didn't learn French by not speaking English. Let me think about that one sec. Give me an analogy of how that works with chronic pain again. Well, I'll get to that in a second. But you agree that you didn't learn French by avoiding English. Right, correct. Okay, you had to actually logically feel like what you wanted to do. Same thing with chronic pain.

You actually can't solve chronic pain by trying to fix chronic pain because where's your attention? Yeah, you're fixating on chronic pain. Right. Okay, what you're doing, you're creating like a virtual desktop on your computer, you're learning a new language, I call it an enjoyable life, which means you have to separate from the chronic pain circuits. Remember, it's an embedded memory. You have to separate first, then redirect. Redirection is my life, meditation, relaxation, also good food, good wine, good friends, etc. And what you're doing, you're creating a vision of what do you want your life to look like?

And then you proceed to execute. In other words, I want to speak French. This is what I have to do to speak French. This is what I want my life to look like with or without the pain. You develop this new language. Remember, the default language is survival, which is going to be threat. And learning this new language, which I call an enjoyable life, is actually a new language. And with repetition, your brain actually starts to physically change. So you develop your vision of where you want to go. Part of my book in stage three is getting organized to execute the plan. So creating a vision of what you want your life to look like is a big deal.

But I do want to say one more thing that's critical, part of this thing, is that one of the hard, fast rules that we've developed, again, evolved, is we do not allow patients to speak about their pain, ever. I did hear you say that on, I think, Pain Reframed, right? What's that? I think I heard you say that on Pain Reframed. I like that. Yeah, I mean, because again, where's your attention? And I didn't realize how much people discuss their pain until we started doing these workshops back in New York. We're doing another one June 7th through 9th at Omega. And in that weekend, almost all the participants go to pain-free in the weekend.

But one of the hard, fast rules that's evolved is you cannot discuss your pain ever. It's now evolved in my office. If you're my patient right now, I say, look, when you walk out the door of my office, you'll never discuss your pain ever again with anybody, especially your family. And a lot of people look at me and go, well, what do I talk about? Anything else? So the problem with providers, especially chiropractors and physical therapists, is that you spend more time with the patients than the physicians do, sad to say for physicians. And I'm guessing a lot of your patients in pain talk about their pain.

Yeah. Well, obviously that's like when someone walks in, like your primary thing is seeing if you're progressing well, right? And so that's the focal attention point. Right. And then, but they keep talking about their pain. So what I want to ask you, I'll ask you the question, do you find yourself drained by certain patients? Definitely, definitely some of them. And something resonated earlier that you said is that kind of the conversation you have with some people, and I've, I've tried to frame it well with them. I'm like, I feel like every time we come you're, we're talking about the same thing again and we don't do anything.

And so I want them, I want to see if a certain thing is going to work with them, but we never get to it because it's the same conversation over again. Do you ever have patients where you just walk out of the room and you feel exhausted? Very few, but I think I'm lucky. You are lucky because most people, every time I talk to any group of providers, it is that people don't like dealing with chronic pain patients because they do complain a lot, they get very frustrated and somewhat aggressive when they don't get their needs met. And then you're working away in somebody in chronic pain for 10 years, you don't see much success a lot of the time, correct?

Yeah. And in my experience with people who are kind of in that realm there, to me they just seem, a lot of them seem like just very, they're just unhappy and I don't know when they got that way, maybe it came before or after the pain, I have no idea, but it seems like it's a common thing, you know what I mean? Right. If you want, I can digress a little bit into how to not, how to actually enjoy treating those patients. Sure. Okay. First of all, the three parts of solving pain is becoming aware of the problem. The second thing is that chronic pain is a complex problem with many parts to it. Medicine right now is guilty of throwing random simplistic solutions at a complex problem.

It always takes multiple strategies to solve chronic pain. Sleep, physical therapy, exercise, nutrition, all these things make a difference and all of them count. It turns out that everything works a little bit in chronic pain, nothing works in isolation. That's why people say, well, I tried mindfulness, it didn't work. I tried chiropractic, it didn't work. I did physical therapy, it didn't work. They're part of it. So better sleep could be 20%, stress reduction could be 25%, 30%, chiropractic care could be 20%. The problem is there's never one solution for chronic pain, which brings us to the third point is that the patient takes charge of their own care.

In other words, chronic pain is complicated. Each person is incredibly complex and individual. The only person that can logically solve their pain problem is just that patient. The first thing I tell every healthcare provider, it took me five years to learn this, at least five years, is that you're not responsible for your person's pain. Period. End of story. They are. Second of all, as a chiropractor, you have certain things you can do very, very well. Your responsibility is to educate the patients as the nature of the, you know, physical problems and maybe alignment issues, et cetera, and do a great job with what you do on that given visit.

That's your only responsibility. Things like the sleep, the stress, the family situations are not your responsibility. So in the big picture, you are not responsible for that person's chronic pain. Then you go into the point where these people start talking to you about their pain. They'll complain about their family issues, their boss, or whoever, and they can talk about it over and over and over again, but it's actually one of the symptoms of chronic pain is obsessive thought patterns because remember this is a memorized problem just like phantom limb pain, I call it phantom brain pain, these obsessive circuits are actually part of the disease and they're not rational.

The more you allow them to talk about it, the worse it gets. That's one of the reasons we don't allow patients to ever talk about their chronic pain. So one question, you don't even have to ask that question, you can ask a different question, how's your function? I ask one question about the pain, that's it. And then you don't want to be draconian about this, you want to get to know the patient number one, but second of all, you say like part of our treatment here is that we're not allowing you to discuss your pain. I also tell my patients no complaining, because again, where's your brain? Right.

Right, okay, so then what you do, you can turn your visit into a mindfulness-based process with maybe nice music, try to give feedback on these sensations that are generated, neutral, positive, negative, again, not compared to the usual pain, just get them into a mindfulness-based treatment program, and just get them to relax, it's a big part of the deal. Because remember, the key, so the ultimate solution, let me jump way into the story just for a second, the ultimate solution to chronic pain is they call it the spiritual journey, which means getting your perspective back. That's good food, good wines, good friends, etc., right?

In other words, you get sucked into this abusive chronic pain, so it's like a cesspool, and the key issue is coming out of the process and giving back, getting your perspective back, which means, and so the antidote to pain is play. So if your body is full of stress chemicals, which doubles the nerve conduction, etc., when you are at play, then your body is full of these chemicals we described earlier that give you a very strong sense of great well-being. There's also a mirror neurons effect, as you yourself learn to enjoy treating chronic pain, and it's an incredibly rewarding experience, by the way, is that you're excited.

Have you heard of this term called mirror neurons, by chance? I have, but if you had me standing in front of a class, it wouldn't worry. I have, though, actually. Yeah. So what happens is I think in the 50s, they were doing experiments on these monkeys with these EEG leads on their head, and one of the researchers was walking down the aisle eating a bag of peanuts, and all of a sudden all these EEG monitors start going off, and they found out that they were actually going to the appetite center of all these monkeys' brains. They've now done many studies with MRI scans, et cetera, showing that when you smile at a baby, for instance, when the baby smiles back, it's not because the baby's happy, it's just that the smiling center of the baby's brain was stimulated.

Same thing, if you walk into your house in a bad mood, you'll notice pretty quickly if you become aware of this, that all of a sudden people around you are in a bad mood. We just stimulated that part of the brain. But if you're in a great mood and excited about coming home or excited about seeing the next patient, and it's really clear on the different therapists that I work with, that patient all of a sudden comes out just different. You've changed your body's chemistry. That's what we think happens at Omega during the one weekend where people go so pain-free. So people feel safe. we have finally realized that people heal each other.

It's not me. It's not a process. It's not a formula. You're connecting the person to their own capacity to heal. That's why you're not responsible for the person's pain. Your role, again, not only, first of all, not letting them discuss their pain, because you learn to have success stories, and I come out of every one of my clinics absolutely energized every time with some of the worst patients you can imagine, but when the patient is somebody who's angry, frustrated and simply won't engage at all, you got to let go. Now, I realized that I lost a significant part of my practice because I said, look, here's the book, here's the website, I'll see you back in a few weeks.

So, again, one possibility is that the way you download the responsibility to the patient for the chronic pain is, look, here's David Hanscom's book or somebody else's book. You want to learn about the pain. You want to learn how it's affecting you and you take charge of your own care. We're going to provide the chiropractic part of it. The book's available on Amazon. The website's completely open source. No emails required, no registration, no products being sold, no advertisements. It's just a website that's completely open source. It will always be that way. So, you can use it tomorrow. There's no, you don't have to copyright, I mean it's copyrighted, but you don't have to have permission to use it.

The idea is you're downloading that responsibility on to the patient, then your job is to do great chiropractic care, but also as you enjoy your patients, it actually wakes up that part of the brain. You know, the interesting thing I've found with some patients, actually I would say this is probably a good majority of them that I've experienced. So I have a bunch of videos, I have a bunch of podcasts, I mean let's just say this, I'll say hey go listen to this podcast, we did it, and they don't do it, and they're free, and I think it's interesting how many people don't take things when they're free, I don't know if it's the population set, I don't know if it's people in general, but when you charge them, I feel like when I charge them even a little bit, enough to kind of hurt, then all of a sudden they take it more serious.

Right, yep, I agree. I think with the, and again I don't know each scenario has to do it differently, but yeah we're creating some products that will be commercial ones that are much more organized than the website. Website's a little unwieldy, but still it's been very effective, but between the book and the website, it's very time efficient because you're not spending the time trying to solve the problems that they are, and I agree with you that I had to give my book away because I can't sell my own book to my patients, right? Right, I do the same thing. I would do, I would ask my patients. What's that?

I do the same thing, I got a book and I get the prints for like $250, so I'm like just take it. Yep, so I give the book to my patients, but if I was not the person selling the book and Amazon, and it does signify a commitment, but we also went out as far as the prognosis of chronic pain, the number one factor that pretends a good prognosis is their willingness to engage. It turns out the expressive writing, really simple one to say yes or no to, and I can tell within minutes whether the person's been doing their writing or not. I mean, they're just different. Second thing is not discussing their pain, very objective thing, and they'll sort of seepishly say, well, I tried it or I didn't.

Then some tipping point, but again, the key issue for you, you're not going to solve every chronic pain patient that comes in the office, but being excited about it helps a lot, but also you can't be drawn in by patients' negativity. So if they insist on complaining, you say, please don't do that. Some patients may not want to come back. You have to be able to take that hit. But at the same time, you just explain this as part of the treatment to get your attention on what we're doing, not on what's outside of this place, which is all the circumstances around their pain, right? And what happens is that I think each provider has a responsibility to preserve their own energies for the people who are open to responding.

And again, we talk about these obsessive circuits that block treatment. You can't reason with them. You're right. And I spent five years arguing with patients, trying to convince them that they wanted to get better. These are irrational circuits and it just wiped me off the map. Invertently, I just say, look, here's some homework. See you back in a few weeks. I want you to learn about pain. Then you can find out really quickly whether they did or didn't engage. But if they didn't engage, then you have your answer. So you do chiropractic care. You just get to know the person. You enjoy what you're doing.

But what you don't want to do is, I guess the key issue of this conversation is you don't want to spend the extra energy trying to get somebody better that's not going to get better anyway. And the people that are listening to your podcast or looking at my book or whatever, then it's game on. And it's pretty fun. Yeah, I agree. Actually, I think I'm doing this unknowingly in a different way. And so when patients, a lot of times they'll say, like I had this one gentleman in one time where he was talking about his knee and he had pain with squatting. And so usually, so in here we'll do some manual therapies and all that kind of stuff.

But also too, there's a lot of resistance training and corrective exercise approach. And so he's talking about it for like five minutes and I'm like, okay, look, let's just drop that for now. I'm like, let's do this movement here and let's do that one, let's do that one, right? And so we did about four things or so and I said, how do those feel? He said, they feel great. Went back to squatting again, it didn't hurt anymore. And like, but we can, we can bicker back and forth about like how his knee feels for 20 minutes, but we wouldn't get anything done. But he was willing to try something different, which I think was nice.

And so he's willing to engage, right? Right. Yeah. And I think you're in a little bit better situation. I want to give this talk to a physical therapist. I mean, they're, I think a little more trapped than the chiropractors are because if you have a patient who, I mean, what happens in my situation, if a patient doesn't want to engage, they just don't come back. Right. They come back next week, I ask them about the material, they say no. I simply ask the question every time I don't fire them. And at some point, if they keep coming back and don't do anything, they say, look, it really is not working for either one of us, I'm just wasting your time.

And they don't come back. And I think you have more leeway in that as a chiropractor than a physical therapist who has patients refer to them by a given provider. Right. Yeah. We're a little bit more standalone. And I, like I've told patients like openly, like on the, like, so the first day, like we will try a couple of things that would be like they're, let's say the mechanical safety net, they're the things that chill them down. And so I tell them, look, next time you're going to come back and I'm going to ask you to demonstrate every single thing we did here, right? And I'm going to know if you did it or not.

And if you didn't do it, we're going to do the exact same thing again and you're going to get really tired of paying me money to show you the same thing again. Right. And so typically they do it, but if they don't do it, I'm a man of my word, we do the same thing again. And I had a lady the other day that did the same, that we did that and I don't think it was that she didn't want to do this stuff. She just was unsure of it. Right. But either way, we did the same thing, same starting point, right? Yep. Like you're writing. No, I agree. I 100% agree with your approach. And I think I hear you saying that you have already done what I suggested, is that you just are not emotionally involved.

Here's your suggestion. She either did or she didn't. And you can sort of get internally frustrated. Well, she's not really compliant. She's not listening to me, et cetera, et cetera. Or you realize that she has a chronic pain disease, which is a disease, by the way, which actually, they've estimated that, by the way, the impact of chronic pain, there's two research papers that show this, that the impact of chronic pain on a person's life is equivalent to terminal cancer. It's a big deal. People die seven years earlier in chronic pain. That's not psychological either because you have this sustained stress response in your body.

It's like driving a car down the freeway in second gear, your body starts to break down. Anyway, going back to your conversation is that there's real suffering. These obsessive circuits are part of the disease, and by not engaging with those and just being objective about it, you don't get worn out, right? I think that the ones that typically, like you said earlier, the ones that don't come back, they're the ones that weren't going to engage anyways. So those drop outs happen, but so the ones that I think of that I've been managing for a very long time and have the same thing, those are the ones that would be the ones that it's kind of like, well, shoot, let's try something different, you know, and they're not always open to it.

Right. But the ones that drop out, it's like, so I agree, it's like they didn't come back, it's not really, like we couldn't do anything about that, right? Correct. So, I'm sure what I'm sure what you're finding out is that what happened in my practice, and I wasn't, I'm not happy about not engaging these patients, I just wish I had some way of doing that, and it's just not rational, and I can't tell how many hundreds of times I've done this. You know, I thought it would work, I would still do it, I still argue with them, I try to get them back in shape, but what happens, I trigger them. They're already triggered anyway, and I make it way worse, it's like pouring gasoline into a fire, so I just learned just to, so what's happened, the ones, the people that are angry don't come back, and what happened in my practice, it turned into an incredibly delightful practice, and the people that came back were curious, they were interested, I was continually energized by their progress, and my practice just became fun.

By the way, in my own chronic pain journey, about six years ago, I made a decision, what is one of the things I can do in my own journey out of chronic pain that would make a difference? I didn't understand the difference between clay chemicals and stress chemicals, and I made a decision just to create an attitude of play at work, and I did, you know, who's this person, enjoy my staff more, enjoy my patients more, and occasionally our staff, our clinic would turn into a bit of a summer camp, just having a good time, but to be a little bit careful of that, but honestly, just taking an attitude of play into everything, and is really critical, I mean, for your work, for your play, and in some ways, you enjoy what you're doing, we put the word play on play, and the word work on work, but really, it's all enjoyable in its own way, and I think they're words that actually are somewhat counterproductive.

I would agree. I think there was a book I read way back in the day, I think it was called Radical Manifestation. Okay. It was based upon the idea that, like, even if you're in a really crappy situation right now, like, say that my computer was bugging out and, like, this podcast didn't go well, then I would, you'd take a step back and you'd figure out, what did I learn from this situation, and how can I thank this situation for teaching me this valuable tool? And the answer with that is, find a better damn internet, and this won't happen again. Right. So, it's, I try to look at each person that way when I engage them, it's like, hmm, how can I navigate this better next time, or I can navigate it better with them, so just the ones that aren't as fun, you know, it's a learning experience for me, personally.

Well, there's a book out, it's on stage two on my website called The Way to Love by Dr. Anthony DeMello. He's a very famous Jesuit priest, one of the most brilliant writers of all time. It's a little two-inch-by-two-inch book. I read it on a regular basis, in fact, I have it right here. My fellows read it, my staff reads it. That is little. Yeah, it's little. We also have a book called Awareness, but it's really the way to awareness. And one of his points he makes is that if you have somebody that you really dislike or upsets you, he says, thank your enemies, because they just told you what got triggered.

In other words, if somebody makes you angry, it's not you, it's them. I'm sorry, it's not them, it's you. In other words, they triggered something in you. You learn to think that person who upset you because they gave you a clue into what's in your brain. And it's exactly what you're saying is that you just, okay, what did the situation tell me? Or you also look at it differently. He talks about being judgmental. Let's say you put a negative label on somebody. All you've done is projected your view of the world onto that person. You actually don't know that person anymore. You've completely blocked awareness.

But what is really interesting, and I sort of figured this out before I read DeMello's stuff, that a positive label does the same thing. What a great guy. Makes sense. I don't really know, I don't know that either. And yet, any label simply blocks awareness. So he takes that a step deeper in just every relationship that you do, every sentence you say, become aware of your words, your reactions on that person, or vice versa. And life becomes remarkably interesting when you quit projecting your view of the world onto everybody and everything. So you become infinitely interesting as opposed to somewhat tedious after a while.

Right, right. Well, good. I didn't think we'd get into this, but I think it's pretty good. Oh. I mean, that's hilarious about the doc. So the doc project is called Direct Your Own Care. It really is, the book's a framework, and again, I would encourage you to look at it just for your patients for an educational structure as well as a framework. But the essence of the solution is connecting a person with his or her own capacity to heal. That's it. And what happens if you're anxious or frustrated or lost awareness, you're in this whirlwind of activity. You're not connected to yourself, not connected to people around you, especially when you're angry and upset, which occurs almost every time in people that are in chronic pain because they're trapped by a very unpleasant sensation.

Why don't you be angry? Sorry about that. It serves a beautiful sound. Yeah, that's my wife. I've got to hang that one up. Sorry. Yeah, it's okay. We learned something from this situation. Yeah, it's actually funny. There was a patient that came in years ago that he was, I still remember because he was unique in the fact that he had the pain that he had had for, I want to say, 20 years or so, and he'd been to tons of people, couldn't figure it out, including me, I couldn't figure it out. He's always so pleasant and finally asked him, dude, you've been in pain for 20 years, how are you so happy?

He's just like, I don't know, it's just not into me to be upset about it. It was interesting because you don't see many of those coming in the door. Remember, happy is the sensation generated by your body's chemistry, right? There's a book Sapiens, which is a best selling book right now, that points out that in the human experience, whether you lived now or a million years ago, really the essence of your sense of well-being is based on your body's chemistry. So before I get interrupted here, the essence of the project is connecting yourself to your own healing capacity, that's it. And then the corollary to that is that you learn to auto-regulate your body's chemistry, so when you're triggered to become where you're triggered, and that sensation of being anxious or frustrated, elevated stress chemicals, and then what you do is you just train your body to flip over into the play chemicals.

And I have a little mantra that came up, a couple of them. One of them is when you're angry and frustrated, while you're not necessarily rational, those are survival reactions, and one of my sayings is no action in a reaction. In other words, if you're reacting and frustrated, you really can't see the situation very clearly. And I've learned, again, with lots of failures, that you just zip it. And five minutes, ten minutes, half a day, whatever it takes, let the reaction pass. Remember, we don't want to suppress it. Then you can address the situation more civilly and clearly. But what's fascinating is that often the situation makes you so angry, it just disappeared.

It isn't even there anymore. But the other one I have is called STS, savor the second. Your mind starts whirling around, and you can just drop your shoulders for a second and just feel the back of your chair, the act of meditation, is I may have been pissed off an hour ago, but guess what? That was an hour ago, that's not the second. So I'm enjoying my conversation with you. I find your questions really excellent, by the way. Oh, thanks. And I enjoy the opportunity to get this word out to other people. That's this second. It wasn't an hour ago. And so really, there's no goal to my process. The only goal if you want to talk about it is just connecting to the second you're in with your pain or without your pain.

So I call it connected and engaged thinking is the key issue here. You're simply connecting to who you are and connecting to what is. And that just changes the body's chemistry dramatically. I don't know why this came to mind. The people not being in the moment because they're in their phones. Right. I don't know if that's a part of anything here. It's a big one. Yep. Huge. And I'm guilty as charged. And I'm trying, one of my goals is to compress my emails, for instance, into shorter periods of time, maybe three times a day. And the problem is I'm driving down the road and doing emails, I'm talking to you and doing emails, I'm trying to watch a Warriors game and watching and doing emails.

It sort of flattens the experience out, right? Right. And really trying to create nice experiences minus social media is a pretty big deal. And I just don't text. I really try hard not to do that. I just go on Facebook very rarely. But all those things flatten out your capacity to connect with what is right in front of you. and there's a book out called Play by Stuart Brown out of Santa Cruz and he points out very clearly that the way human consciousness evolved is through play. In other words, you're on the playground, we watch young animals and other, you know, let's say young leopards for instance, you're wrestling and tussling around.

But with play, with another real person, you have sight, all your senses are involved, you learn negotiating skills, you learn language skills, and that's how the human consciousness evolved is with play. Anger, frustration, survival part is in every animal. It's already there. But what makes humans human is their capacity actually to talk and play. And what's really disturbing about human consciousness, we often engage acts that are actually worse than other creatures. Because we intellectually know better, there are behavioral patterns of survival when, again, those are a million times stronger than the conscious brain, it's the only way you can understand why we do such horrible things to other people when we know better.

We know better. Right. Yeah. That'd be a whole other two-hour conversation. Right. Why do people do stuff to each other? No, it's a behavioral pattern. No, it's really clear, actually. I mean, okay, so, we get upset when somebody goes into school and starts shooting kids, right? Mm-hmm. What about genocide? I mean, we have whole countries killing people off and never think it's okay, but somehow, depends on what the politics are, we'll let another country get away with it, right? Mm-hmm. We all of us know better. Yeah. But the behavioral patterns are a million times stronger than the conscious brain.

And I'd love to have another conversation with you because I can get very philosophical about how I understand that anxiety is not psychological. Trying to avoid anxiety drives much of human behavior. Unless we actually get this diagnosis correct with the correct treatment paradigm, this is a human survival problem. Because, remember, the antidote to anxiety is control. In other words, something causes anxiety, you control it, problem solved, anxiety drops, right? Mm-hmm. When you lose control, your body kicks in more stress chemicals in an effort to regain control. That's anger. In other words, anger and anxiety are the same thing.

It's just a spectrum. And that's what you look at a societal anger right now. People live longer. There's more years to be trapped by your thoughts. And, again, the social media issue is what it is. But what drives almost all really bad human behavior is relentless anxiety that translates into anger. Right. Because you're trapped. You're trapped by your thoughts. You're trapped by circumstances. Your body's fully stressed chemicals. You're not really rational. The behavioral patterns win. And one website called Societal Disintegration, Anxiety, and Anger. And as long as you keep treating anxiety slash mental pain as a psychological issue, we're in deep trouble.

And medicine is missus. Actually, Sigmund Freud figured this out in the 1880s. And when he published his material, he got thrown out, he got laughed out of the room. He didn't really write on it again until 1938, 39, before he died, about this whole process of the neurochemical basis of existence. But he figured that he was a neurologist, not a psychiatrist originally. So he figured this thing out over a century ago. Modern medicine is completely, I don't want to say the word missed it or ignored it, but the modern neuroscience research is incredibly compelling. We know the answer to this problem, and we're not acknowledging it.

Yeah, I'm sure there's multiple variables why someone might or might not use these strategies and so on. I can tell you from my personal experience that I think up to the first four or five years of practice, I didn't really learn much of the new stuff besides what I was already doing. Correct. And so it'd be nice if, can we just take a healthcare provider and take their soul and knowledge and hand it to the next generation so we don't have to keep relearning the same darn things again? Well, we can get, you know, I'm writing this book to you, you really need spine maturity, but what's happened is that we're actually unlearning our stuff.

We know that the essence of being a doctor is actually caring for the patient, right? We're not doing that anymore. We're not listening, we're not spending the time. Most of the procedures we do, at least in spine surgery, have actually been documented to be ineffective. We're literally pretending to practice medicine. It's been shown in animal studies that when you repeatedly dash hopes you induce a depression, you come to me as a surgeon, I promise a cure that actually doesn't work. I charge a lot of money for it. It doesn't work. I just dashed your hopes, right? Right, yeah, because that was the, let's just say that was the last effort, that was the last thing.

Now there's nothing else. Where do you go? Then where do you go? So what's happening right now is that the business of medicine is creating disability as fast as it can. It's a major societal problem. I think a lot of the homeless situation we're dealing with right now is because of the corporate medicine. We know that administrator salaries have gone up at 3,000% compared to about 10% for physicians. And the corporate medicine right now is just absolutely robinous, clean. It's really a big problem. Yeah. Well, what the heck? You're already out of practice. I got to deal with this now. I'm talking to you.

I'm writing books. I'm going big. I'm going big. Good. Well, I'm glad you are. I hope we can get this message. So currently there's about, I think each episode gets about 1,400 downloads. Okay. Great. Some good ears will hear it. Okay. As we start to wrap up here, is there any last words and how can people reach you? Well, I would encourage you to look at the book Back in Control. Even if you don't have chronic pain, it's a great stress management tool. Everybody has anxiety. This relentless anxiety is probably the biggest problem. And just look at the word anxiety as the reason to look at it.

I'd also encourage you, the book's just a book, so look at the website and start engaging in the action steps that allow you to regulate your body's chemistry. And not only do people come out of chronic pain and their anxiety drops, they begin to thrive at a level they never thrived at before. They begin to thrive at a level they never thrived at before, and it's just been incredibly rewarding to watch this happen. So the steps are simple, not very hard, and they can usually get a hold of me, I think my email is right on the website, backandcontrol.com. I should take a look right here. Oh, so backandcontrol.com, and then I'm guessing about.

Cool. Well, if I'll search for it on here and I'll put on the show notes for everybody as well. Okay. Sound good? Yeah, and if there's any providers who want me to talk to their groups, I can do Zoom meetings, etc. you know, again, for providers, it's a different paradigm shift putting responsibility out of the patient, but it is incredibly rewarding, and I'm a certain, I mean, the last seven years of this whole process have just blown me out of the water as far as how rewarding it is. So instead of being part of that group who really, I was like everybody else, really dreaded seeing somebody in chronic pain because they didn't know what to do, it's by far and away become the most rewarding part of my practice, which is a complete surprise.

Nice, nice. Well, thank you so much for being on. This was great. Thank you. I really enjoyed it. Thank you so much, David, for being on. That was amazing. Thank you, thank you, thank you. Again, if you guys want to reach him, I will put his link in the show notes as well as contact information. So you can find the show notes at p2sportscare.com. That's P, the letter, two, the number, sports is plural, care.com. And there is a comprehensive search function. Go on there and type up David Hanscom. I'm going to spell Hanscom real quick because I am really bad at this thing. Okay, David Hanscom. David, David.

Let's look it up. Okay, everyone knows how to spell David. I'm so excited. Okay, so I'm going to spell David just because I'm bad at this. So H-A-N-S-C-O-M. I don't know if people are meant to have last names at all, at least not in my universe. So anyways, check out his stuff. I think the message is very nice. It's nice to put patients in charge of their own problems and to empower them. I think that's what the whole thing is really about. As always, leave each other a bit in how you found them. And if you're dating, dating Eagle Scout. I'll see you guys soon.