Author: David Hanscom, MD
Library: Newbooks
Foreword: My Journey Out of Pain (by Mark Owens)
Wildlife biologist Mark Owens recounts his devastating 2006 horseback riding accident in Montana that shattered ribs and broke his spine. After two surgeries, years of escalating pain, and medication addiction, he was told his only option was a radical multi-day surgery. Seeking a second opinion from Dr. Hanscom, he learned his pain was likely neurophysiologic disorder (NPD). Skeptical but desperate, Owens tried expressive writing and experienced an 80% reduction in chronic pain within two days. Over a year later, he remains largely pain-free without analgesics.
Introduction
Dr. Hanscom describes his own fifteen-year descent into chronic pain beginning in the late 1980s, when panic attacks and sixteen NPD symptoms—including severe OCD—nearly destroyed his career, marriage, and will to live. In 2002, discovering expressive writing pulled him out of his tailspin within weeks, and all symptoms resolved over six months. He introduces the DOC (Define Your Own Care) program, a self-directed, systematic approach addressing sleep, anxiety, medications, anger, goal setting, and physical conditioning. He shares how requiring pre-surgical DOC engagement led to over fifty patients canceling surgeries because their pain disappeared.
Chapter 1: The Pathway into Chronic Pain
Hanscom explains that chronic pain is a maladaptive neuropathological disease state driven by the nervous system, not simply a structural problem. He introduces the “junction box”—the brain’s constant interpretation of sensory input as pleasant, unpleasant, or neutral—producing either reward chemicals or stress chemicals. Thoughts are sensory input; unconstructive repetitive thoughts flood the body with stress hormones, creating a sustained fight-or-flight state. Functional MRI research demonstrates that emotional and physical pain activate overlapping brain regions. He describes the “personal brain scanner”—the brain’s default negative scanning for danger—which generates endless irrational anxieties.
Chapter 2: The Source of Your Pain
Hanscom categorizes pain sources into three types: structural (identifiable on imaging, matching symptoms), non-structural (inflammation, overuse, soft-tissue issues invisible on imaging), and neurophysiologic disorder (NPD)—the nervous system generating its own pain signals. He argues that degenerative disc disease is widely misunderstood: multiple studies show little correlation between disc degeneration and low back pain. He presents the case of Joni, who had severe spinal degeneration yet zero back pain. Triggers function like a “light switch”: the brain flips the switch but sensation is felt distally. Hanscom shares his own NPD struggle with migraines, OCD, and panic attacks—sixteen of thirty-three NPD symptoms—before resolving them through self-discovered tools. Surgery is likened to dental work: effective only when a clear structural problem is identified.
Chapter 3: Imbedding Pain Pathways
Repeated pain impulses cause the brain to process them more efficiently, requiring less stimulus to elicit the same response. A 2004 fMRI study showed chronic pain patients had five brain areas activated versus one in healthy subjects. A 2013 study demonstrated that chronic low back pain had shifted to emotional brain centers—where the pain “driver” was completely different. Phantom limb pain illustrates how deeply memorized pain circuits persist even after the physical source is removed. Drawing on Dan Coyle’s The Talent Code, Hanscom explains that pain pathways become imbedded through repetition and myelination—faster than skill pathways because impulses fire like a “machine gun.” Three coping strategies reinforce circuits: suffering (complaining, arguing), suppressing (which creates rebound effects via Wegner’s “White Bears” experiment), and masking (addictions, distractions). All three prevent healing and deep, connected living.
Chapter 4: The Modifiers—Sleep and Anxiety
Adequate sleep (seven to eight hours) is an absolute requirement for chronic pain recovery. A major Israeli study showed insomnia induces chronic pain, not the reverse. Anxiety is not primarily psychological but a programming phenomenon where negative thoughts etch neurological circuits. Using David Burns’s cognitive distortions and William Glasser’s Choice Theory, Hanscom shows how “stories” become reality. He critiques marketing’s deliberate creation of anxiety, familial imprinting in the first twelve years of life, cultural programming through fear, and the myth of self-esteem. The chapter’s breakthrough: Hanscom discovered that diminishing anxiety matters more than alleviating pain. He developed “prehab”—having patients engage the DOC process before elective surgery—leading many to cancel surgery entirely. Herbert, wheelchair-bound from severe spinal stenosis, cancelled surgery the Friday before Monday’s operation and returned to hunting elk after expressive writing alone.
Chapter 5: The Ultimate Modifier—Anger
Anger is “anxiety with a chemical kick”—when attempts to meet basic needs fail, the body floods with adrenaline. The anger sequence flows: circumstance → blame → victimhood → frustration and anger. Chronic pain sufferers eventually hit “the Abyss”—losing control of pain, finances, activities, and hope. The desperate need for validation drives frustration, and patients become obsessive about missed diagnoses. People conceal victimhood through strong opinions, self-pity, suppression, or perfectionism. Hanscom confesses disguising anger was his most highly developed skill. The victim role offers hidden “benefits”—lowered expectations, entitlement, self-righteousness—but 30–50% of chronic illness patients drop out of treatment, preferring familiar suffering over change. Harry Harlow’s “Pit of Despair” experiments with primates demonstrated learned helplessness mirroring chronic pain patients’ depth of despair. Anger remains the greatest obstacle to a healthy, pain-free life.
Chapter 6: Processing Stress
Pain, anxiety, and anger form a “terrifying triad” that is neurologically linked—other life stresses increase pain because these circuits are intertwined. Hanscom shares compelling cases: a woman with a bone spur whose sciatica resolved within three months of working through situational losses without surgery; George, a banker whose pain vanished after processing his grief over his son’s death. Managing stress requires building energy reserves (sleep, exercise, social time) and plugging the drain—anxiety-driven anger. The bathtub metaphor: no matter how much water you pour in, an open drain prevents filling. “Toughing it out” and positive thinking are both variants of suppression that eventually collapse. The essence is separating yourself from your reaction to stressful events—awareness, separation, and reprogramming. Using Dr. Fred Luskin’s forgiveness exercise, Hanscom demonstrates that you can train your body to stop reacting physiologically to adversity.
Chapter 7: Awareness
Awareness is seeing the world as it actually is, not through preprogrammed perceptions. Hanscom reflects on fifty years of profound unawareness, building a persona while connected to his identity rather than his true self. At a Hyde School seminar, twelve of eighteen participants wrote “David, you don’t listen”—a painful but transformative moment. Four levels of awareness: environmental awareness (active meditation, shifting the nervous system), full environmental immersion (passion displaces pain circuits, as with Fred building motorcycles), emotional awareness (requiring vulnerability since anger blocks it), and judgment/storytelling (recognizing cognitive distortions and how they solidify into destructive stories). Hanscom provides a daily practice: notice reactivity, calm down through active meditation, recognize stories and projections, consider the other person’s perspective, then decide to enjoy the day. An awareness mantra anchors the process: “I am whole and powerful / I am loving and harmonious / I am forgiving and happy / I am peaceful.”
Chapter 8: Stimulating Your Brain to Change—Neuroplasticity
The brain is in continuous dynamic change through neuroplasticity. Chronic pain causes measurable brain shrinkage, but this reverses when pain resolves. Foundational programming in the first twelve years absorbs negative behaviors and labels that become identity. Facilitating neuroplasticity requires calming the chemical environment and stimulating new circuit structure—methods include meditation, mindfulness, CBT, expressive writing, sleep, and massage. Creating alternative pathways requires awareness, separation, and reprogramming. Hanscom illustrates with his son’s friend Holt winning a U.S. skiing championship through internal visualization (not positive thinking). The chapter also addresses thought suppression via Wegner’s research, introduces “separation” as the critical step, and discusses the power of play to reactivate dormant brain pathways and gratitude to change one’s narrative. Pavlov’s experiments and ballet dancers’ pain tolerance demonstrate that pain thresholds are programmable through repetition.
Chapter 9: Embarking on Your Journey
The DOC process is presented in four stages: laying the foundation, forgiveness and play, moving forward, and expanding consciousness. The central paradox: chronic pain becomes unresolvable by trying to resolve it, because attention to pain pathways reinforces them. Instead, the awareness-separation-reprogramming sequence replaces traditional problem-solving. Three flawed strategies are critiqued: positive thinking (a form of suppression), mind over matter (like a Chinese finger trap—pulling harder tightens the grip), and talking pain to death (complaining reinforces pathways and drives away social support, as demonstrated at an Omega workshop where banning pain discussion accelerated healing).
Chapter 10: Stage 1—Laying the Foundation
Five foundational steps: (1) Confirm your diagnosis and catalog symptoms, sleep quality, stress levels, and medications. (2) Expressive writing—writing freely and destroying the paper—supported by over two hundred research papers; handwriting over typing for its complex brain activation. The “unhooking from the train” metaphor illustrates how writing disconnects you from past thoughts. The three-column technique from Burns’s Feeling Good operationalizes awareness, separation, and reprogramming simultaneously. (3) Active meditation—relax, stabilize, focus on one sensation—in five to ten seconds. (4) Don’t share pain, as complaining reinforces pain circuits. (5) Prioritize sleep as the number-one rehabilitation factor.
Chapter 11: Stage 2—Forgiveness and Play
Anger is the antithesis of creativity (the “C”/see must come first in “creative” versus “reactive”). Six steps to reconnect with creativity: understand anger’s impact, acknowledge disguises, admit victimhood, choose not to be a victim, forgive, and play. Dr. Fred Luskin’s Forgive for Good framework provides strategies like “changing the channel” and taking 100% responsibility for your anger. Three failed approaches to forgiveness: positive thinking (suppressing rage), extreme belief systems (rigid thinking as disguised anger), and intellectual versus heartfelt forgiveness. The story of patient Alan illustrates how positive-thinking armor prevents healing. Play is the most powerful exit from the Abyss—re-engaging creatively with family, friends, and activities stimulates widespread brain circuits that make pain pathways dormant.
Chapter 12: Stage 3—Moving Forward
Maintain Stage 1 and 2 practices indefinitely rather than quitting when you feel better. Five steps for moving forward, with repetition as the key to reprogramming. Hanscom’s own daily routine of small commitments—expressive writing, active meditation, gym workouts—keeps NPD symptoms at bay; quitting writing predictably triggers relapse within weeks. The “power of commitment” is illustrated by his son Nick and friend Holt skiing an impossibly narrow chute at Snowbird. Practical guidance includes rebuilding family relationships (never engage while angry, listen without unsolicited advice, hold weekly meetings), organizational skills (David Allen’s Getting Things Done), and connecting with a life vision—the story of Ralph, who improved physically but retired early because he lacked a vision beyond pain.
Chapter 13: Stage 4—Expanding Your Consciousness
Five steps expand consciousness: (1) Pass Through the Ring of Fire—a three-circle model from compassion-focused therapy (outer ring = achieving, middle ring = threat, center = contentment). Hanscom’s personal story of living in the outer ring from age fifteen until severe OCD and anxiety collapsed his facade around 2002. (2) Step Into Your New Life—pursue authentic interests rather than chasing happiness as a permanent state. (3) Fail Well—resilience is a bamboo grove that bends and stands back up; pain pathways are permanent and flare-ups don’t mean despair. (4) Look Up—your spiritual journey means experiencing life from outside yourself, gaining a larger perspective. (5) Give Back—empathy naturally develops as you reconnect with your authentic self. Closing Epictetus quote: “We are what we repeatedly do. Excellence, then, is not an act.”
Chapter 14: Sleep
Restful sleep is the single most critical first step in resolving chronic pain. A step-by-step treatment ladder: sleep hygiene (consistent schedule, dark/cool room, no screens), bedtime stress management (expressive writing before bed), regular exercise, over-the-counter medications (melatonin, antihistamines), prescription sleep medications (Ambien, Remeron, amitriptyline), cognitive behavioral therapy for insomnia (CBT-I), addressing childhood trauma revealed through ACE scores (Hanscom’s own ACE score was 5), and formal sleep disorder evaluation for resistant cases like sleep apnea. Combining sleep medications with the full DOC program is essential.
Chapter 15: Medication and Chronic Pain
Medication is an adjunct to the DOC program, never the solution itself. Hanscom limits medications to four categories: narcotics (opioids), anti-anxiety drugs, sleep medications, and anti-seizure/membrane stabilizers. He excludes muscle relaxants as ineffective. While opioids can help immobilized patients start moving, he warns of tolerance, fuzzy thinking, constipation, addiction risk, and paradoxically increased pain sensitivity (opioid-induced hyperalgesia). Anti-inflammatories often outperform low-potency narcotics for direct pain relief. The overarching principle: minimize total medications, view them as temporary aids, and make medication-free living the ultimate goal.
Chapter 16: Effective Rehabilitation
Rehabilitation cannot succeed without first calming the nervous system; aggressive treatment on a fired-up system worsens pain. Effective physical therapy requires: thorough assessment, patient education (“back school,” understanding disc degeneration as normal aging), advanced manual therapy (joint mobilization and myofascial work), specific and progressive exercise, and a long-term home conditioning program. The whole kinetic chain—especially hip mobility—must be addressed. Diagnostic examples: IT band tendonitis mimicking sciatica, hip arthritis mistaken for lumbar radiculopathy. Long-term success requires gym-based weight training three to five hours per week. Soft tissue desensitization breaks the cycle of injury→anxiety→guarding→stiffness→more pain.
Chapter 17: Expanding Your Horizon
Gratitude requires conscious effort because the brain’s default mode fixates on danger. Hanscom recommends reading history to gain perspective (Viktor Frankl’s concentration camp insights; Stephen Greenblatt’s The Swerve on Dark Ages brutality). The “Journey of 1,000 Moons” metaphor—hand-painted gypsum moons representing ~1,000 lunar cycles in a 77-year lifespan—underscores life’s brevity. Self-discovery tools include the Hoffman Process (seven-day intensive workshop breaking entrenched neurological pathways), psychotherapy, self-help books (which can become substitutes for actual change), and structured seminars. Reconnecting with family and friends is critical—as different brain circuits reawaken and reward chemicals flood the body, thinking becomes clearer regardless of pain. The essence: move forward with your life with or without pain; waiting for pain to abate first means pain is running the show. “Welcome to your new life.”
Appendix A: Do You Really Need Surgery?
A scathing critique of unnecessary spine surgery. Devastating case studies: George lost bowel and bladder function; Teresa was fused from neck to pelvis after a simple bruise; Tom became partially paraplegic; Amanda endured four failed fusions in five years; Doug reached twenty-nine surgeries after a likely unnecessary initial fusion. Hanscom documents how financial incentives distort care: cortisone injections lack evidence; spine fusion success rates are below 30% at two years; electronic medical records profile physicians by profitability. His “prehab” protocol requires eight weeks of DOC engagement before any surgical decision. Over fifty patients with severe structural problems cancelled surgery because symptoms resolved during prehab—putting him “out of business.” Eugene Carragee’s Stanford study showed only 27% success for discogram-identified patients, below even the placebo response. The “disaster factor” of failed surgery must be fully understood: each failed procedure can cascade into worse outcomes.
Appendix B: Self-Inventory Template
A structured self-assessment framework covering core values, character strengths and flaws, skill levels, dreams, a five-year vision across all life areas, and an annual action plan. The template guides readers to take stock of their whole life, not just their pain, as part of the DOC process.
